Dip - Principles of Nutrition and Behaviour - Draft

LIST OF ABBREVIATIONS
USA United States of America

MSG Monosodium glutamate
PKU Phenylketonuria
RD Registered Dietitian
SES Socioeconomic status
CNS Central Nervous System
PUFA Polyunsaturated fatty acids
DHA Docosohexaenoic acid
AA Essential fatty acids
IQ Intelligence quotient
HDL High Density Lipoproteins
NAD Nicotinamide adeninedinucleotide
DNA Deoxyribonucleicacid
GIT Gastrointestinal tract
IDA Iron Deficiency Anemia
PEM Protein energy malnutrition
DSHEA United States Dietary Supplement Health and Education Act
CAM Complementary and Alternative medicine
LDL Low density lipoproteins
UL Upper Limit
MAO Monoamine oxidase
SJW St. John’s Wort
HIV Human Immunodeficiency Virus
HFCS High fructose corn syrup
ADHD Attention deficit hyperactivity disorder
AMP Adenosine monophosphate
MEOS Microsomal ethanol oxidising system
GABA gamma Aminobutyric acid
BAC Blood alcohol content
WKS Wernicke Korsakoff Syndrome
FASDs Fetal Alcohol Spectrum Disorders
FAS Fetal Alcohol Syndrome
BED Binge eating disorder
CBT Cognitive Behavioural Therapy
IPT Interpersonal psychotherapy
DBT Dialectical behaviour therapy
BMI Body Mass Index
BMR Basal Metabolic Rate
ATP Adenosine triphosphate
LPL Lipoprotein lipase
VLCD Very low calorie diet
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Table of Contents
ACKNOWLEDGEMENT.................................................................................2
LIST OF ABBREVIATIONS............................................................................3
Module Introduction.....................................................................................9
Module Competences.................................................................................10
Module Outcomes......................................................................................10
Module Learning Strategies........................................................................10
Module Learning Logistics/Resources........................................................10
Module Assessment....................................................................................10
UNIT 1: INTRODUCTION TO PRINCIPLES OF NUTRITION AND BEHAVIOUR
..................................................................................................................11
1.1 Meaning of terms............................................................................11
1.2 Introduction to nutrition and behaviour.........................................12
1.3 Historical perspective.....................................................................13
1.4 Summary........................................................................................15
1.5 Check your understanding.............................................................15
UNIT 2: CONCEPTS AND MODELS IN NUTRITION AND BEHVIOUR..........16
2.1 Objectives.......................................................................................16
2.2 Introduction...................................................................................16
2.3 Scientific method............................................................................17
2.4 Ethical issues.................................................................................18
2.5 Nutrition quackery and psychological misconduct..........................20
2.6 Summary........................................................................................21
UNIT 3: RESEARCH METHODS AND ANALYTICAL STRATEGIES...............23
3.1 Objectives.......................................................................................23
3.2 Experimental approaches...............................................................23
3.2.1 Limitations of experimental studies..........................................24
3.2.2 Examples of experimental studies.............................................24
3.2.3 Independent and Dependent Variables.....................................25
3.3 Co-relational approaches................................................................26
3.3.1 Co-relational designs................................................................27
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3.4 Food selection behaviour................................................................28
3.5 Summary........................................................................................28
UNIT 4: DIRECT EFFECTS OF NUTRITION AND BEHAVIOUR....................30
4.1 Objectives.......................................................................................30
4.2 The central nervous system and behaviour.....................................30
4.3 The role of nutrients in brain development.....................................32
4.3.1 Lipids and fatty acids................................................................33
4.3.2 Macro and micronutrients........................................................33
4.3.3 Polyunsaturated and fatty acids................................................34
4.4 Breastfeeding versus formula feeding.............................................34
4.5 Cholesterol and adult behaviour.....................................................35
4.6 Cholesterol and antisocial behaviour..............................................35
4.7 Cholesterol and cognitive function..................................................36
4.8 Summary........................................................................................36
UNIT 5: ROLES OF NUTRITION AND BEHAVIOUR.....................................37
5.1 Objectives.......................................................................................37
5.2 To explain the role of macro and micronutrients on behaviour.......37
5.3 B Vitamins, central nervous system and behaviour........................39
5.4 Minerals, central nervous system and behaviour............................42
5.5 Summary........................................................................................44
UNIT 6: EFFECTS OF CHRONIC AND ACUTE FORMS OF MALNUTRITION 45
6.1 Objectives.......................................................................................45
6.2 Protein energy malnutrition............................................................45
6.3 Short term effects of nutrition and behaviour.................................47
6.3.1 Malnutrition effect cycle............................................................47
6.3.2 Behavioural Effects of Severe Malnutrition................................48
6.3.3 Effects on children and adults..................................................48
6.4 Summary........................................................................................49
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UNIT 7: DIETARY SUPPLEMENTS, MENTAL PERFORMANCE AND
BEHAVIOUR..............................................................................................50
7.1 Objectives.......................................................................................50
7.2 Dietary supplements and cognition.................................................50
7.2.1 Examples of supplements with beneficial health claims............51
7.3 Herbal supplements and behaviour................................................53
7.4 Summary........................................................................................56
UNIT 8: BI-BEHAVIOURAL AND PSYCHOLOGICAL INFLUENCE ON
NUTRITION................................................................................................57
8.1 Objectives.......................................................................................57
8.2 Bi-behavioural influence on nutrition.............................................57
8.2.1 Genetic and Biological Determinants of Nutrition- Behavior
Paradigm.............................................................................................58
8.2.2 Disease, Aging and Other Physiological Differences...................59
8.2.3 Ethnicity/ Culture/ Social Interactions....................................61
8.2.4 Eating attitudes........................................................................62
8.3 Psychosocial health and psychosocial determinants.......................64
8.4 Summary........................................................................................67
UNIT 9: STIMULANTS, DEPRESSANTS, SWEETNERS AND FOOD
ADDICTIVES..............................................................................................68
9.1 Objectives.......................................................................................68
9.2 Dietary sugar and behaviour..........................................................68
9.2.1 Metabolism of sugar..................................................................69
9.2.2 Sugar and cognitive behavior....................................................69
9.2.3 Sugar and mood.......................................................................70
9.2.4 Sugar and hyperactivity............................................................70
9.3 Caffeine, methylxanthines and behaviour.......................................71
9.3.1 Modes of Action of caffeine within the central nervous system
(CNS) 73
9.3.2 Physiological Effects of Methylxanthines on Body Systems.......74
9.4 Food addictives and behaviour.......................................................75
9.5 Summary........................................................................................77
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UNIT 10: ALCOHOL BRAIN FUNCTIONING AND BEHAVIOUR....................78
10.1 Objectives.......................................................................................78
10.2 Interaction between alcohol and nutrients......................................78
10.2.1 Alcohol effects on digestion and absorption of essential nutrients
79
10.3 Alcohol consumption, brain functioning and behaviour..................83
10.3.1 Alcohol, gender and cognitive behavior.....................................84
10.4 Alcohol consumption and pregnancy, fetal alcohol syndrome.........85
10.1 Summary........................................................................................87
UNIT 11: EATING DISORDER SYNDROMES...............................................88
11.1 Objectives.......................................................................................88
11.2 Introduction...................................................................................88
11.2.1 Risk factors for eating disorders................................................88
11.3 Anorexia nervosa............................................................................89
11.3.1 Diagnostic criteria for anorexia nervosa....................................90
11.3.2 Physiological consequences.......................................................90
11.3.3 Anorexia Treatment..................................................................93
11.4 Bulimia...........................................................................................93
11.4.1 Major Types of Bulimia.............................................................94
11.4.2 Diagnostic criteria for bulimia...................................................94
11.4.3 Consequences of purging in bulimia nervosa............................94
11.4.4 Psychological characteristics of bulimic individuals..................95
11.4.5 Bulimia Treatment....................................................................96
11.5 Binge eating disorder......................................................................96
11.5.1 Causes of binge eating disorder................................................96
11.5.2 Signs and symptoms of binge eating disorder...........................97
11.5.3 Binge Eating Disorder Treatment..............................................97
UNIT 12: BEHAVIOURAL ASPECTS OF OVERWEIGHT AND OBESITY.......99
12.1 Objectives.......................................................................................99
12.2 Introduction...................................................................................99
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12.3 Etiology of obesity.........................................................................100
12.4 Social cultural correlates..............................................................100
12.5 Physiological consequences..........................................................100
12.5.1 Consequences of being overweight or obese............................101
12.6 Biological influences.....................................................................101
12.7 Behavioural influences.................................................................103
12.7.1 Energy expenditure.................................................................103
12.7.2 Energy intake.........................................................................103
12.8 Restrictive feeding practices..........................................................104
12.8.1 Very low calorie diets..............................................................104
12.8.2 Yo-yo dieting...........................................................................104
12.9 Preventive approaches..................................................................104
12.9.1 Weight management...............................................................105
12.10 Treatment and preventive approaches.......................................107
12.10.1 Surgery................................................................................107
12.10.2 Drugs...................................................................................108
12.11 Check your understanding........................................................109
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Module Competences
Enable the learner apply concepts and principles of nutrition and behaviour
Module Outcomes
By the end of this module the learner should;
1. Appreciate the importance of nutrition and behaviour
2. Explain the relationship between nutrition and behaviour
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UNIT 1: INTRODUCTION TO PRINCIPLES OF NUTRITION AND
BEHAVIOUR
Unit objectives
By the end of this unit the learner should be able to;
1. Define terms used in nutrition and behaviour

2. Explain nutrition and behaviour
3. Explain the historical perspective of nutrition and behaviour
1.1Meaning of terms
Abnormality – something deviating from normal, or differing from normal or
differing from the typical. It is subjectively definesbehavioural
characteristics assigned to those with rare or dysfunctional conditions.
Behavior – this is the way in which one act or conducts themselves
especially towards others. It is the way in which an animal or person acts in
response to a particular situation or stimulus.
Cognition – refers to mental processes involved in gaining knowledge and
comprehension. These processes include: thinking, knowing, remembering,
judging and problem solving (the higher level function of brain). It also
encompasses language, imagination, perception and planning.
Cognitive functions – they are cerebral activities that lead to knowledge,
including all means and mechanisms of acquiring information. They include
reasoning, memory, attention and language and leads directly to attainment
of information of information and that is knowledge.
It not only refers to influencing factors but also to health, environmental,
social and economic implications along the entire product chain from the
farmer to the consumer.
Lethargic - low in activity or display of energy, disinterested in the
environment and flat in affect.
Malnutrition refers to deficiencies, excesses, or imbalances in a person’s
intake of energy and/or nutrients.
Normal – the word is used to describe individual behavior that conforms to
the most common behavior in a society. Definitions of normal will vary
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depending on person, time, place and situations. It also changes along with
changing society standards and norms.
Nutrition behavior is framed by biological, anthropological, economic,
psychological, socio-cultural and home economics related determinants and
it is shaped by the individual situation.
Nutritional behavior is the sum total of all planned, spontaneous or
habitual actions of individuals or social groups to procure, prepare and
consume food as well as those actions related to storage and clearance.
Quack - derived from quacksalver, an archaic term used to identify a
salesman who quacked loudly about a medical cure such as salve, lotion.
1.2Introduction to nutrition and behaviour

Recently, knowledge from three different lines has together illuminated the
complex interactions between nutrition and related environmental factors,
on one hand, and behavior on the other hand. The three advancing areas
are the behavioural sciences, knowledge of the effects of specific nutrients
on the brain function and the study of gross malnutrition in underdeveloped
regions of the world and its impacts on behavior.
The study of human behavior is one of the major advances of the 20 th
century starting with Freud’s discovery of the importance of early traumatic
experiences in the development of neurotic disorders in adulthood. He tried
to bring to understanding the interaction between nature and nurture i.e to
recognize the multiple determinants of human behavior ranging from genetic
to environmental.
As the above developments were being made, in the understanding of
behavior, important discoveries were being made in the field of nutrition.
Goldberger was the first to observe that a specific nutritional deficiency
could cause marked behavioural abnormalities. Through epidemiological
studies, he discovered the causal relationship between nicotinic acid
deficiency and deficiency and pellagra, which is characterized clinically by
diarrhea, dementia and dermatitis. This helped to lay the foundation for
understanding the role of specific nutritional factors in behavioural
functions.
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Although the behavioural effects of concurrent infantile malnutrition were
recognized early in populations living in poverty, it is only recently that the
long-term effects of early malnutrition have been identified. it has been
concluded that early malnutrition is responsible for long-term behavioural
changes, many of which limit a child’s ability to adapt successfully
Diet affects our quality of life and impacts behaviour affecting our emotions
and maybe even how we think for example hunger will cause discomfort,
while a full stomach brings contentment. From the beginning of recorded
history right up through the present, humans have believed that the food
they eat can have a powerful effect on their behavior. Currently thousands
still believe that a type of diet or a particular nutrient can help to achieve
sexual, emotional or cognitive equilibrium.
Numerous fads, statements are increasingly being circulated in the press,
sometimes marketed to sell a product. Fortunately unlike in past centuries,
a lot of research has been carried out to distinguish fact from fiction on the
diet and behavior connection.
A phenomenal amount of research on feeding behavior and the effects of
nutritional deprivation has been conducted using animal models, as there
are certain manipulations that cannot be done with humans.
The area of nutrition and behavior is interdisciplinary in that, in order to
provide objective data and verify some of the claims, information is borrowed
from various disciplines such as anthropology, psychology, biochemistry,
medicine, public health and sociology. How or what a person eats obviously
determines nutritional status, but our approach to behavior will consist of
far more than the behavior of eating. This includes looking at factors that
determine food selection, behaviorand how it affects diet selection. Global,
cultural and familial factors may influence food preferences, how income
determines food choice.
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1.3Historical perspective
Ancient Egyptians, for example, believed that salt could stimulate passion,
onions induce sleep, cabbage prevents a hangover, and lemons protect
against ‘the evil eye’.
The ancient Greeks also thought that diet was an integral part of
psychological functioning, but added a personality component to the
process. They conceived of four temperaments, that is, choleric,
melancholic, phlegmatic and sanguine, that were responsive to heat, cold,
moisture and dryness.
Choleric – ‘the achiever’. Short tempered and irritable. Tends to like hot food.
Melancholic – ‘the naturally gifted’. Analytical and quiet. Tends to like cold
food.
Phlegmatic – ‘the loyal friend’. Relaxed and quiet. Tends to like moist food.
Sanguine – ‘the life of the party’. Social and optimistic. Tends to like dry
food.
During the middle ages, the view that food and health were connected as
medieval men and women used food in an attempt to both encourage and
restrain their erotic impulses. Figs, truffles, turnips, leeks, mustard and
savory were all endowed with the ability to excite the sexual passions, as
were rare beef in saffron pastry, roast venison with garlic, suckling pig,
boiled crab and quail with pomegranate sauce. To dampen sexual impulses,
foods such as lettuce, cooked capers, rue and diluted hemlock-wine
concoctions were sometimes employed, though seldom as often as the
stimulants.
The French philosopher and gourmand Jean Anthelme Brillat-Savarin
wrote ‘Tell me what you eat, and I will tell you what you are’ in his treatise,
The Physiology of Taste, first published in 1825. He postulated a number of
direct relationships between diet and behavioural outcomes, being among
the first to document the stimulating effects of caffeine. He also believed that
certain foods, such as milk, lettuce or rennet apples, could gently induce
sleep, while a dinner of hare, pigeon, duck, asparagus, celery, truffles or
vanilla could facilitate dreaming.
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In the early years of the last century a diet was believed to affect mental
health, intelligence, spirituality and sexual prowess. One of the most
prominent leaders of this movement was John Harvey Kellogg – known best
for introducing breakfast cereals who lectured widely throughout the USA,
promoting the use of natural foods and decrying the eating of meat, which
he believed would lead to the deterioration of mental functioning while
arousing animal passions. He further claimed that the toxins formed by the
digestion of meat produced a variety of symptoms including depression,
fatigue, headache, aggression and mental illness, while spicy or rich foods
could lead to moral deterioration and acts of violence.
In the later centuries, the interaction between nutrition and behavior have
lead to numerous claims such as monosodium glutamate (MSG) causes
headaches and heart palpitations, refined carbohydrates cause criminal
behavior in adults, bee pollen has been advocated as a means to enhance
athletic prowess, garlic as a cure for sleep disorders, ginger root as a remedy
for motion sickness, ginseng as an aid to promote mental stamina, and
multivitamin cocktails as a tonic for boosting intelligence. This is why well
controlled studies are essential to validate or discredit such claims. Since
some may be based on anecdotal evidence, insufficient observations,
misinterpretation of findings or just poor science.
Whether concerned with ensuring our mental health, reducing our levels of
stress or simply losing weight, most of us share a belief that diet and
behavior are intimately relate e.g. eating an energy bar yourself in the belief
that it helps in concerntration, or consumption of herbal supplements by
the elderly to slow aging. it would help you concentrate, while you observe
your parents attempting to slow the aging process by trying the herbal
supplement they see advertised on a nightly infomercial. While we may not
think we are exactly what we eat, we nevertheless seem predisposed to
accept claims about nutrition and behavior that promise us whatever we
think is desirable, no matter how improbable. Our task throughout this
book will be to help you recognize the associations that current scientific
evidence suggests are most likely true, given our current understanding of
work that bridges nutrition and behavior
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1.4Summary
 There is a relationship between nutrition and behaviour which affects our
life, food selection, emotions and thoughts
 From history, numerous theories have been made about nutrition and
behaviour
 Nutrition and behaviour is interdisciplinary in nature
 Scientific research is essential in distinguishing fact from fiction when it
comes to claims on nutrition and behaviour
 Data on nutrition and behaviour is constantly evolving.
1.5Check your understanding
1. Differentiate between normal and abnormal
2. How does your behaviour affect nutrition?
3. What claims have you heard about nutrition and behaviour?
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UNIT 2: CONCEPTS AND MODELS IN NUTRITION AND BEHVIOUR
2.1Objectives
 To explain concepts and models in nutrition and behaviour
 To describe the scientific method
 To identify ethical issues
 To outline nutrition quackery and psychological misconduct.
2.2Introduction
The relationship between nutrition and behaviour is circuitous i.e. nutrition
affects, modify or influences behavior e.g. affecting performance, but that
behavior can be just as powerful in determining nutritional status or diet
quality. In most cases the relationship between nutrition and behaviour is
not as direct as it involves other variables. Behaviour can
influencenutritional status or diet quality. For example:
 A malnourished person is likely to be lethargic. An adequate diet is
necessary for the individual to exhibit a reasonable amount of activity
therefore under nutrition is having an effect on active behavior. Severe
malnutrition can greatly depress physical and cognitive functioning.
 Conversely, an individual who participates in exercise and body building
to regain muscle tone may find themselves hungry more often. This
means that the active behavior is having a direct effect on the nutritional
status of that individual i.e. increase in energy intake as a result of
increase in physical activity
 From a behavioural perspective, an attention seeking individual tends to
enjoy hot, spicy foods like chilli peppers.
 An insecure individual may starve themselves to fit into a group or join a
sports team.
 Individual who have experience happy childhoods may cook more
unhealthy food.
 Skipping a meal such as breakfast can reduce a child’s attention span on
a learning task while substances such as caffeine, a natural ingredient of
coffee but an additive to certain soft drinks, will boost attention and
arousal. In contrast, a high-starch meal may serve to calm a stressed
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adult just as much through its perception as a comfort food as by its
facilitating the release of neurotransmitters.
 An overweight or obese child may not be physically active at school and
maybe due to bullying by peers the child may snack excessively, spend
more time indoors, further leading to less activity.
 Phenylketonuria (PKU) is an inborn error of metabolism that results in
mental retardation in childhood if unidentified and left untreated. In
infants with the disorder, the absence of a single enzyme – phenylalanine
hydroxylase – prevents the conversion of the amino acid phenylalanine
into tyrosine. The ingestion of a normal diet, containing typical amounts
of protein, results in the accumulation of phenylalanine, which in turn
exerts a toxic effect on the central nervous system. The effects are
manifested in the form of severe mental retardation, decreased attention
span and unresponsiveness. Fortunately, the early detection of PKU,
through a newborn screening test, can allow for immediate treatment
through a low protein diet, which avoids the certain likelihood of any
brain damage. Nevertheless, this example shows the powerful effects that
diet can impose on a developing infant. Mentaldevelopment can also be
impaired due to deprivational dwarfism is a condition of retarded growth
and mental directly attributable to a caregiving environment that is
characterized as emotionally detached and lacking in normal affection.
Infants reared by hostile parents, or by caregivers that are emotionally
unavailable and who do not respond to the infant’s signals for attention,
often fail to thrive and show stunted growth with little interest in their
environment. Despite regular feedings, adequate nutrient intake, and no
metabolic irregularities, a lack of environmental stimulation in infancy
will here have as powerful an effect on the developing infant as did
undetected PKU in the previous example. It is almost certain that a
normal diet for a PKU baby will have devastating consequences, no
matter a good caregiver–infant relationship. But an infant deprived of
appropriate behavioural interaction with a caregiver will also be delayed,
no matter how optimal the nutrition.
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2.3Scientific method
The scientific method is the approach used by all scientists despite their
background in their efforts to identify the truth about relationships between
natural events. It comprises of the following series of steps:
a. State the research question – scientists can build upon a theory they
encounter, personal observation or on previous research and will pose a
research question that has a relevance to the phenomenon of interest.
b. Develop a hypothesis – the researcher formulates the research question
into a hypothesis that can be tested.
c. Test the hypothesis– a systematic plan is designed, implemented by
conducting the study, appropriate date is collected and then analyzed.
This can be done by conducting a survey, using questionnaires that
demographic information include
d. Interpret the results – Based on the results of the study, the scientists
either accepts or rejects the hypothesis and have the research question
answered. Conclusions are then derived solely from the data.
e. Disseminate the findings–this can be achieved through publishing the
results, presentations such that others may replicate, learn from or
constructively critique the results.
Reviewing the literature on a topic is a critical phase of the research process
to identify whether the research has already been done, current gaps or to
compare findings from similar findings which can be obtained from a wide
array of sources such as books or internet.
2.4Ethical issues
The formal codification of ethical guidelines for the conduct of research
involving humans, at least in the USA, began well over 50 years ago in the
aftermath of the Second World War. In 1946, a number of Nazi physicians
went on trial at Nuremberg because of research atrocities they had
performed on prisoners as well as on the general citizenry. For example,
dried plant juice was added to flour fed to the general population in an
experiment aimed at developing a means for sterilizing women, while men
were exposed to X-rays without their knowledge to achieve the same effect.
In another experiment, hundreds of prisoners in the Buchenwald
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concentration camp were injected with the typhus fever virus in an effort to
develop a vaccine.
After the trial and through the efforts of the Nazi War Crimes Tribunal,
fundamental ethical principles for the conduct of research involving humans
were generated and made part of the Nuremberg Code, which sets forth 10
conditions that must be met before research involving humans is ethically
permissible. Primary conditions being:
 Voluntary consent
 Benefits should outweigh the risks
 The subject should be in a position to terminate participation at will.
Despite these rules being in place, numerous instances of abuse of human
beings have occurred after 1946 incidences all in the name of research.
Examples of research atrocities
- Tuskegee Syphilis Study where black men with syphilis were left
untreated to track its effect. The study was started in the 1930s with
men had not given their informed consent. However, when penicillin
became available in the 1940s the men were neither informed of this nor
treated with the antibiotic
- From 1946 to 1956, mentally retarded boys at the Fernald State School
in Massachusetts who thought they were joining a science club were fed
radioactive milk with their breakfast cereal. The researchers were
interested in how radioactive forms of iron and calcium were absorbed by
the digestive system.
- In 1963, studies were undertaken at New York City’s Chronic Disease
Hospital to gather information on the nature of the human transplant
rejection process. Patients who were hospitalized with various debilitating
diseases were injected with live cancer cells, with the rationale that the
patients’ bodies were expected to reject the cancer cells.
- From 1963 to 1966 ‘mentally defective’ children at the Willowbrook State
School in New York were deliberately infected with the hepatitis virus,
drawn from the infected stools of others or in a more purified form. The
investigators argued that since their contracting hepatitis was likely to
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occur anyway, much could be learned by studying the disease under
controlled conditions.
This prompted the need to design comprehensive systems for research
involving humans. In 1974, the National Research Act (PL 93-348) was
signed into law and established the National Commission for the Protection
of Human Subjects of Biomedical and Behavioural Research to identify the
ethical principles that should guide the conduct of all research involving
humans. The Commission’s efforts resulted in a document called The
Belmont Report – Ethical Principles and Guidelines for the Protection of
Human Subjects, which was published in 1979. This report outlines three
basic ethical principles:
1. Respect for persons. This principle requires that researchers acknowledge
the autonomy of every individual, and that informed consent is obtained
from all potential research subjects (or their legally authorized
representative if they are immature or incapacitated).
2. Beneficence. This principle requires that researchers treat their subjects
in an ethical manner not only by respecting their decisions and protecting
them from harm, but also by making efforts to secure their wellbeing. Risks
must be reasonable in light of expected benefits.
3. Justice. This principle requires that selection and recruitment of human
subjects is done fairly and equitably, to ensure that a benefit to which a
person is entitled is not denied without good reason or a burden is not
imposed unduly. It is clear then that all researchers have a fundamental
responsibility to safeguard the rights and welfare of the individuals who
participate in their research activities. In addition, government regulations
require that any institution that conducts federally-funded research must
adhere to the principles of The Belmont Report.
2.5Nutrition quackery and psychological misconduct
Professional conduct should always be adhered to in any field. Confidential
information should not be disclosed unless to a professional also handling
the case. Any consulting or clinical relationship by a psychologist should be
terminated if it is found not to be beneficial to the client. A professional
should have a licence after completion of internship and training as per
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their field of study. Suspension or termination can occur due to violation of
any of the above.
For the most part, individuals do not have to possessa particular credential
to call themselves a nutritionist. They may have had some
nutritioncoursework, or may have had none at all. Theymay have an
advanced degree, or may not havea diploma from an accredited college. Even
if they have an advanced degree, however, it neednot be in nutrition,
medicine, or even science.
In the same manner, a nutrition credential exists in the form of the

Registered Dietitian (RD). The designation indicates that the individual has
completed at least a Bachelors degree from an accredited college/ university,
has mastered a body of nutrition related courses, has successfully
completed a supervised work experience and has passed a national
qualifying exam.
For example, an individual could claim to be anutritionist, nutrition expert,
nutrition consultant or nutrition counsellor armed only with theconfidence
of having taken some nutritioncourses.
Nutrition quackeryoccurs mainly due to the broad nature of nutrition
presenting both financial and physical danger. Lack of laws preventing
selling dietary supplements. Lack of credentials for nutritionists. Finding
that go public before publication
Certain populations are particularly target for quackery e.g.

- Those who believe testimonials that they hear regarding health claims of
supplemental products.
- Those suffering from incurable diseases and are desperate for a cure
- Those who may simply mistrust the medical or scientific establishment
and services offered therein.
- Athletes who want to boost their performance
- Teenage girls
How to spot nutrition quacks
 They display credentials that are not recognized by a credited institution
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 They promise quick, dramatic and miraculous cures
 They use disclaimers filled with medical jargon
 They claim that most of the population is poorly nourished.
 They advise that supplements offset a poor diet
 They state that research is ‘currently underway’ indicating that there is
no current research.
 Lists ‘good’ and ‘bad’ foods.
 Non-science based testimonials supporting the product, often from a
highly satisfied customer.
 They allege that modern processing removes all nutrients from foods
 They claim that everyone is in danger of food poisoned by our food supply
chain
 They recommend that everyone should take nutrients and food
supplements
 They promise quick and easy weight loss for individuals
 They advise people not to trust conventional medicine
2.6Summary
 The relationship between nutrition and behaviour is bi-directional and
complex
 Research is undertaken using the scientific method for both nutritional
and behavioural sciences
 Ethical principles must be adhered when conducting research.
 Nutrition quacks present a danger in the field of nutrition
1. Explain the bi-directional relationship between nutrition and behaviour
2. Expound on literature review
3. State six ethical principles to be observed when undertaking research
4. Outline standards of professional conduct a nutritionist should observe
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UNIT 3: RESEARCH METHODS AND ANALYTICAL STRATEGIES
3.1 Objectives
 To describe experimental and co-relational approaches in research
3.2 Experimental approaches

Experimental designs have the potential to identify causal links between diet
and behavior. Where a co-relational study may include a number of
variables, equivalent in value until associations are determined, an
experimental study includes two specific types of variables i.e. Independent
and dependent variables
An independent variable is that which is manipulated in the experiment
and constitutes the treatment that the subjects receive e.g. a nutrient may
be added to subjects’ diets or a nutrition lesson is applied to a given class.
A dependent variable refers to the outcome, measure or observation which
results from the manipulation of a specific dietary component.
If the manipulation significantly alters the form or magnitude of a
behavioural measure, a causal relationship can then be suggested.
Elements of sound experimental nutrition-behavior studies
a. A minimum of two groups of subjects i.e. the treatment group (those to
which the manipulation is subjected) and the control group (those which
receive no treatment. Serve as a standard on which comparisons are
made). Using a control group makes it possible to eliminate alternative
explanations for changes in the dependent variable, such as maturation,
history or other experiences aside from the treatment. Any difference that
is seen between the treatment and control groups at the end of the
experiment can therefore be attributed to the independent variable
therefore groups should similar in all respects prior to the application of
the treatment.
b. Random assignment – the subjects are randomly assigned to one group
or the other.
c. The placebo effect –this refers to the phenomenon that when human
beings take any treatment that they believe will be beneficial, their
chance of improving are increased. It is particularly relevant when
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carrying out studies where subjects have reason to expect that by
receiving a treatment, their behavior or feelings of well-being will change.
If this is applied, the researcher will have 3 groups of subjects i.e. control
group (given no treatment), treatment group (receive the treatment) and
placebo group (receive a mock treatment).
d. Double blind conditions- neither the individuals who are collecting data
nor the subjects know whether the subjects are receiving the treatment
or placebo
3.2.1 Limitations of experimental studies
 The sample should differences randomly distributed
 The duration of treatment matters when determining behavioural effects;
one treatment cannot provide information about chronic or long term
exposure
 Variables such as timing of the experiment may influence behavioural
effects
3.2.2 Examples of experimental studies
a. Dietary challenge study
Behavior is usually evaluated for several hours after the subjects have
consumed either the substance being studied or a placebo. This
approach is also referred to as a between subjects design. An advantage
of this approach is that double-blind procedures are usually easy to
implement, as the food component can be packaged so that neither the
subjects nor the experimenter can detect what is being presented
b. Crossover design
Half of the subjects are given the food component on the first day of
testing and the placebo on the second, while the other half are given the
placebo on the first day and the treatment on the second. In this manner
each subject experiences both the treatment and serves as his or her own
control, and the N-size has in effect been doubled. This approach is also
referred to as a within subjects design.
c. Dietary replacement studies
Behavioural effects of two diets – one containing the food component of
interest and the other as similar as possible to the experimental diet
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except for that component – are compared over a period of time. For
example, regular tub margarine could be replaced with a fat substitute in
order to determine if subjects will compensate for the reduction in
calories by eating more food. Such a manipulation would be relatively
mild if done over a day or two, but differences in energy intake could be
attributed to a change in perceived hunger due to the experiment. An
obvious advantage of dietary replacement studies is that chronic dietary
effects can be examined. However, it is often difficult to make two diets
equivalent except for the food component that is being studied, making
double-blind techniques relatively hard to employ. Furthermore, it is
usually not feasible to test more than one dose of the dietary variable,
and replacement studies are usually expensive and time consuming.
d. Quasi- or naturalistic-experiments are sometimes conducted when a
characteristic or trait that cannot be manipulated is the variable of
interest. For example, one would not intentionally deprive children of iron
to observe the behavioural effects of anemia. However, one could identify
children who were alike on a number of variables (age, SES) except for
the presence or absence of iron deficiency, and compare their
performance on a battery of psychomotor tests. In such a study, iron
deficiency would be viewed as the independent variable. Alternately,
researchers who study the effects of breastfeeding on infant behavior
recognize that mothers cannot be randomly assigned to breast- or bottle-
feed their infants. Therefore, great pains must be taken when sampling to
ensure that mothers who breast- or formulafeed are alike on as many
demographic measures as possible.
3.2.3 Independent and Dependent Variables

Independent variables
Organismic or individual characteristic e.g. weight, gender, personality and
diet history
Social and cultural factors- common types of food originating and eaten in a
region
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Setting and context e.g. phenomenon of people eating and drinking more
when they are in a social situation like a party
External cues – eating regulated by external cues e.g. time as opposed to
feelings of hunger
Cognitions about food – ideas about food
Palatability of food – refers to ease in acceptance of food e.g. eyeballs, dog
meat may be palatable in some countries
Nutrient-related or energy density of food – eat because of a deficiency or for
energy
Food characteristics e.g. texture, volume, liquid or solid and its influence on
consumptive behaviour
Dependent variables
Amount consumed or rate of eating- the manner in which the subject
approaches the meal e.g. eating vegetables first
Manner of eating
Frequency of ingestion –how the meals or snacks are spaced
Motivation for food – reason for eating a particular food e.g. an advert on ice
cream may make you want to eat it
Physiological responses e.g. increase in heart rate after ingesting caffeine or
sweating after eating chilli
Judgement of food quality – how factors such as taste and texture
determines food enjoyment
Hedonic ratings – an individual perception on food
Feeling of hunger or satiety
3.3 Co-relational approaches

Co-relational studies determine whether or not two or more variables are
correlated. This means that an increase in one variable corresponds to
either increase or decrease on another variable.
They are used to identify associations between variables and in nutrition
research to generate hypothesis about the manner in which certain nutrition
and behavior variables are related. For example a relationship between diet
and certain behavior; Low iron intake leads to low concentration, fatigue.
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The linkages between two or more variables are determined by use of
statistical procedures that produce an index of association known
correlation coefficient which reflects the strength as well as the direction of
relationship.
Nothing is manipulated in a co-relational approach; the investigator
observes or measures a number of variables of interest. Observation is the
primary means of obtaining data which is then analyzed.
Example 1:
In a study done to ascertain whether the intake of chocolate reduces
depression in women. An inverse relationship was shown to exist between
chocolate and depression meaning there was a negative relationship
between chocolate consumption and depression and conclusion can be
made that; those that consume chocolate or at high intake scored low in
depression.
Example 2:
Suppose a researcher wants to study the relationship between sugar and
hyperactivity, researcher might ask a group of children to complete a diet
record of everything they ate over a weekend and request the parents to
report how active their children were using a standardized activity rating
scale. The researcher then determines the total sugar content of children’s
diet using dietary assessment methods.
Similarly, the children’s score on the activity scale could be tabulated with
higher scores indicating higher activity levels i.e. is it really the case that
children who ingested more sugar also displayed higher activity? Let us
assume that the study concluded that it is indeed found that there was
significant positive relationship between sugar intake and activity level. It
might be easy to conclude that consumption of sugary food causes
hyperactivity but that conclusion may not be necessarily true because there
are several conditions that affect behavioural outcomes.
The following therefore are conditions that must be met before such results
can be accepted as valid:
o Obtain valid measures of nutrient intake i.e. use accepted dietary
assessment methods e.g. the 24-hr recall method
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o Use appropriate sampling technique, a larger sample size is preferred
since if the sample is too small the probability of observing relationships
between a nutrient variable and particular behaviour is reduced thereby
leading to establishment of non existing relationships. Very large samples
lead to many false positives
o Consider sampling of behaviour e.g. rating of activity levels, sociability
and aggression will be rated
o Co- relational studies cannot establish causality (cannot show cause)
3.3.1 Co-relational designs
Epidemiological studies - It include large sample sizes as well as large
numbers of variables. Observation is the main method of data acquisition.
The retrospective approach consists of obtaining data on a pool of subjects,
but instead of linking nutritional status to certain behaviours by drawing on
an array of concurrent measures, efforts are made to identify relevant
variables from the past that may help to inform the present circumstances.
E.g. a psychologist handling a client with anorexia nervosa will identify
factors in the individual’s family history relevant to his/her condition.
The cross-sectional approach- a crosssection of the population with diverse
income, ethnicity, or geographic region are of interest are surveyed. In the
behavioural sciences, however, the cross-sectional design refers to a study
in which subjects of different ages are observed in order to determine how
behaviormay change as a function of age e.g. the use of supplements across
different age groups
The longitudinal design- the investigator would identify a group of subjects,
observe them in regards to a variable of interest and study them on separate
occasions. This design is time consuming and expensive. It is primarily for
this reason that longitudinal studies of adults are conducted by research
groups at institutes or universities, where several investigators (with a large
budget) can arrange for their successors to continue to gather the data. For
example, the Fels Research Institute began the Fels Longitudinal Study in
1929 in Yellow Springs, Ohio, in order to study the effects of the Great
Depression on child development. Psychological data were collected for well
over 40 years, with a switch to physical growth measures in the mid-1970s.
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Dozens of individuals are enrolled every year, with data now available on the
children, grandchildren and great-grandchildren of the original volunteers.
Similarly, the Framingham Heart Study was started in Framingham,
Massachusetts, by the National Heart Institute in order to identify the
general causes of heart disease and stroke. A cohort of 5209 adult men and
women were enrolled in 1948, with the subjects returning every 2 years for
extensive physical examinations. A second generation of enrollees began
participating in 1971. Since its inception, over 1000 research articles have
been published using this database, with much of our present knowledge of
cardiovascular risk factors derived from the study
3.4 Food selection behaviour
The food choice will depend on three factors:
Who? The characteristics pertaining to an individual be it descriptive (age,
sex), biological (hereditary, health) or personality based (activity, mental
state)
Where? It relates to the physical environment e.g. (place, time of food choice,
socio-cultural norms and context that influence the individual decision
making.
Why? Food perceptions that relate to the individual’s food choices based on
belief or sensory attributes as opposed to hunger cues. E.g. familiarity,
taste, cost, convenience, prestige, cognitions
3.5 Summary
 The proper way to establish validity of claims about nutrition and
behavior is to employ established scientific research methods which are
mainly summed in experimental or co-relational methods.
 Co-relational approaches are useful in identifying associations between
different variables
 Experimental approaches are useful in determining causality
3.6 Check your understanding
1. Define the term false positives
2. State the advantages and limitations of co-relational studies
3. Dose response is an example of experimental studies. Explain how a dose
response experiment is carried out
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4. Describe two studies done using co-relational and experimental
approaches respectively
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UNIT 4: DIRECT EFFECTS OF NUTRITION AND BEHAVIOUR
4.1Objectives
 To describe the central nervous system and how it relates to behaviour
 To establish the roles of nutrients in brain development
 To compare breastfeeding and formula feeding
 To explain the relationship between cholesterol and adult, antisocial
behaviour and cognitive function.
4.2The central nervous system and behaviour
The brain-behavior connection
In humans, changes in behavior are ultimately as a result of changes in the
functioning of the central nervous system (CNS) i.e. whatever affects the
brain affects behavior. Diet exerts an effect on both the developing and
mature brain.
Constituents of the diet i.e. minerals, vitamins and macronutrients have
been shown to influence brain function.
Structure and development of the central nervous system
It is composed of two major components i.e. the brain and the spinal cord.
The brain and spinal cord are completely surrounded by three layers of
tissues known as meninges. The brain weighs about 1.4kg and lies within
the cranial cavity. Some parts of the brain are cerebrum (largest part of the
brain), hypothalamus (controls appetite and satiety, control thirst and water
balance, regulate body temperature), and thalamus (center of recognition,
process of some emotions and complex reflexes), mid brain, pons, medulla
oblongata and cerebellum.
Neurons/nerve cells comprise about half of the volume of the brain and form
the structural foundation of the organ.
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Neurons – are the information processing and transmitting elements of the
CNS. Their capacity to perform this function depends on their ability to
generate and conduct electrical signals as well as to manufacture and
transmit chemical messengers.
No two neurons are identical. However, most share certain structural
features i.e. the soma, the dendrites and the axon. Their special properties
allow them to function as the components of rapid communication network.
Soma/cell body – contains the nucleus of the neuron. They form the grey
matter of the nervous system
Dendrites – fine extensions that branch out to form tree-like structures.
They receive and carry incoming impulses towards cell bodies.
Axon – they carry impulses away from the cell body and are usually larger
than dendrites.
As mentioned earlier, diet exerts an effect on both the developing and
mature brain. Specific constituents of the diet i.e. minerals, vitamins and
macronutrients have been shown to influence brain function. Nutrients and
growth factors regulate brain development during the fetal and neonatal
stages.
Recent research has shown essential fatty acids and certain amino acids to
play a role in brain development and functions. Various parts of the brain
are directly affected by both short term and long term nutrient deficiency.
The development of the CNS is critical in determining the cognitive
capabilities of individuals e.g. the neural tube which is a precursor to the
CNS is affected by nutrient inadequacy such that if it does not close
properly a number of possible anomalies can result e.g.
i. Anencephaly – occurs when the forebrain fails to develop properly
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ii. Spina bifida – results from failure of closure of the posterior portion of
the neural tube.
These anomalies can be prevented through increased intake of folic acid in
the diet.
Research has also suggested that behavioural maturity results not only from
synaptic formation that occurs at birth but also from elimination of excess
connection and the increasing efficiency of those connections that remains.
Nutrients play a key role during perinatal period i.e. 20 weeks of gestation –
28 days after birth. This is because a number of neurons and myelination
process are being established.
4.3The role of nutrients in brain development

The chemistry and function of the developing and mature brain are
influenced by diet. Large gaps exist at the biochemical, physiological and
behavioural levels in terms of our knowledge of the precise effects of
nutrition on brain functioning.
Vitamins, minerals and macronutrients, have long been shown to influence
brain function. In recent decades research has further determined that
essential fatty acids, as well as certain amino acids, also play a role in brain
development and function.
All life processes are subjects to the influences of biological and nurturing
factors and ultimately to their interaction. These include brain growth and
development, and their function outcome (behavior).
Nutrition is an environmental factor as it represents access to resources
from the environment (i.e. food and water). However, unlike other
environmental resources like medical care, education or experiences,
nutrition can directly modify gene structure and mediate the expression of
gene factors by providing the specific molecules that enable genes to exert
their potential or targeted effects on brain growth and development.
The brain is a specialized tissue in which functionality depends on
generation and conduction of gene impulses. These special functions of
brain is reflected in a higher need for certain nutrients such as choline, zinc,
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vitamin A, folic acid, iron and special fats i.e. essential fatty acids
(docosahexaenoic acid, arachidonic acid, gangliosides and sphingolipids).
Therefore, poor nutrition contributes to delays in intellectual development
by causing “brain damage, enhancing the risk of illness, inducing lethargy
and withdrawal or delayed physical growth”. Brain “damage” refers to
relatively straightforward nutrient-induced structural or biochemical
alterations.
Illness delays the development of motor skills (e.g. crawling and walking)
thus limits the child’s exposure to and exploration of the external
environment. Similarly, delayed physical growth, lethargy and withdrawal
would limit the child’s exploration of the external environment and
incorporation of new knowledge from external stimuli.
4.3.1 Lipids and fatty acids

Nutrition during the first year of birth is also important as the brain
continues to develop. Up to about 60% of an infant’s total energy intake
during the first year of birth is used by the brain in constructing neuronal
membrane and disposing myelin. Most of this energy comes from dietary fat.
Lipids account for over half the dry weight of the brain. Lipids found in the
brain include: cholesterol, phospholipids, gangliosides and other fatty acids.
Cholesterol is a key component of neuronal plasma membrane and regulates
and maintains internal environment of the nerve cell.
During intra-uterine growth, the fetus synthesizes its own cholesterol but at
birth most of the plasma cholesterol comes from the high density
lipoproteins.
Cholesterol appears to be involved in regulation of brain function as it
modulates the activities of neurotransmitter receptors.
4.3.2 Macro and micronutrients
Macro and micronutrients largely affect brain behavior in that, deficiency
and inadequate intake of various nutrients manifest in different behavioural
outcomes. For example:
 Under nutrition during development adversely affect the growth of the
brain e.g. production of myelin.
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 General reduction of nutrient intake e.g. protein impairs brain growth
and lipid deposition altering the composition of myelin.
 A deficiency in niacin impairs myelination and vitamin B 6 deficiency
reduces the levels of myelin lipid and polyunsaturated fatty acid in
cerebellum hence affecting movement and coordination.
 Folate deficiency in mothers appears to have a greater likelihood of
delivering of infants who display malformations of the CNS.
 Zinc and copper deficiency are damaging to the maturation of the brain.
 Sodium and potassium are necessary for electrical activities, fluid
balance and synaptic communication.
 Selenium facilitates antioxidant activities.
4.3.3 Polyunsaturated and fatty acids
PUFAs, that are located on the cell membrane phospholipids serve as
important structural components of the brain. The major brain PUFAs are
docosohexaenoic acid (arachidonic acid and adrenic acid).
PUFAs sources are prevalent in green plants, algae, and phytoplankton on
which fish feed, fish oils are a rich source of docosohexaenoic acid (or DHA),
while egg lipids can provide both DHA and arachidonic acid (AA).
linoleic acid (omega-6) and alphalinolenic acid (omega-3) are precursors of
these PUFAs and must be obtained from the diet because they cannot be
synthesized. They are termed essential fatty acids (EFAs) and if provided by
the diet, the CNS and liver have enzymes that can convert them into the
longer chain PUFAs.
Vegetable oils are a rich source of both linoleic and alphalinolenic acids. The
long-chain DHA and AA fatty acids are believed to be critical components of
membrane phospholipids and major constituents of the nervous system.
DHA is present in high concentrations in the retina. In the brain, DHA is
most abundant in membranes that are associated with synaptic function,
and is accumulated in the CNS late in gestation and early in post-natal life.
4.4Breastfeeding versus formula feeding
Breast milk contains DHA which is essential in nerve functioning.
There have been frequent claims that breastfed infants tend to be smarter
than those who are formula fed. Research done earlier indicate that children
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who are breastfed for ten months or more have higher IQ scores than those
who are formula fed or weaned by four months of age.
From a scientific standpoint however, breastfeeding is not the only factor
that favors breastfed infants since many studies have also shown that,
breastfeeding is also associated with higher social-economic status,
maternal IQ and maternal education though this is still subject to ongoing
research.
Higher social-economic status is a marker for more involved parenting
which translates into more attention being paid to infants either into
reading, playing and an all-round caregiving all of which facilitate cognitive
development.
A major difference between breast milk and commercial formula is the
absence of certain fatty acids in the latter, notably DHA.
4.5Cholesterol and adult behaviour

Research has shown that there is a link between cholesterol and behavior in
that, newborns exposed to higher levels of cholesterol through breastmilk
are better able to cope with dietary cholesterol as adults.
Lowering cholesterol levels in adults to reduce risk of cardiovascular
diseases can be achieved through improving the diet, increasing level of
physical activity and not necessarily through intake of antilipidemicdrugs.
Since a lower than optimal cholesterol has been associated with mortality.
This mortality is related to behavioural factors resulting from depression e.g.
suicides, homicides and accidents.Statins is a class of drugs that inhibit the
enzyme that controls the metabolic pathway that provides cholesterol in
liver. They are particularly effective and much prescribed. More evidence
exists that statin use may reduce the risk of depression although some
research suggests that results may differ by sex, with fewer depression
symptoms in women and more in men.
4.6Cholesterol and antisocial behaviour

The relationship between cholesterol and non-illness-related deaths remains
controversial as contrary data exists. A small body of literature links low
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serum cholesterol levels (i.e below 160-180mg/dl) to psychiatric and
behavior manifestations of effective disorders and violence. For example,
individuals with antisocial personality disorder whether psychological or
social, have been shown to have lower levels of cholesterol.
Lower cholesterol concentrations have also been observed in prisoners,
homicidal offenders, patients hospitalized for violence, and those who
attempt suicide
Violent suicide attempters were found to have the lowest total cholesterol
(140mg/dl), followed by non-violent suicide attempters (165mg/dl), followed
by non-suicidal healthy control group (194 mg/dl).
Low cholesterol may therefore influence mood and suicidal behavior, but
perhaps as likely, mood and medication, via their influence on eating and
exercise, may serve to reduce cholesterol levels.
It has therefore been concluded that a low fat or low-cholesterol diet results
in a variety of anti-social behavior.
4.7Cholesterol and cognitive function

Following animal studies, dietary manipulations may modify behavior by
changing brain cholesterol levels and the fluidity of neural membranes
However, in humans, almost no research has been conducted on the role of
cholesterol and learning ability, although some other aspects of cognitive
functioning have been explored such as memory. For instance, a study on
some elderly individuals found high total cholesterol or high density
lipoprotein (HDL) to be associated with better memory function.
Others have found the opposite patter; that higher total cholesterol may be
associated with higher rates of dementia in elderly.
Another study of the possible effects of cholesterol on children found no
associations with their cognitive academic performance. Beyond childhood,
however, the current assessment shows that higher levels of cholesterol are
the most detrimental in middle-age adults and most beneficial in the elderly.
Numerous studies though need to be done before a conclusion is reached on
cholesterol directly affect cognitive functioning.
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4.8Summary
 The chemistry and function of the developing and mature brain is
influenced by diet therefore whatever affects the brain affects
behaviour
 Macro and micronutrients play a crucial role in brain development.
 Numerous studies still need to be done on the relationship between
cholesterol and behaviour
1. Research on the relationship between cholesterol and behaviour
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UNIT 5: ROLES OF NUTRITION AND BEHAVIOUR
5.1 Objectives
 To explain the role of macro and micronutrients on behaviour
 To explain the role of vitamins in the CNS and behaviour
 To explain the role of minerals in the CNS and behaviour
5.2 To explain the role of macro and micronutrients on behaviour

A person’s food intake affects mood, behavior and brain function. A hungry
person may feel irritable and restless, whereas a person who has just eaten
a meal may feel calm and satisfied. A sleepy person may feel more
productive after a cup of coffee and a slight snack. A person who has
consistently eaten less food or energy than needed over a long period of time
may be apathetic and moody.
The human brain has a high energy and nutrient needs. Changes in energy
or nutrient intake can alter both brain chemistry and the functioning of
nerves in the brain. The intake of energy and several different nutrients
affects levels of chemicals in the brain called neurotransmitters (transmit
nerve impulses from one nerve cell to another). Neurotransmitters influence
mood, sleep patterns and thinking.
Deficiencies or excesses of certain vitamins or minerals can damage nerves
in the brain, causing changes in memory, limiting problem-solving ability,
and impairing brain function.
Several nutritional factors can influence mental health such as: overall
energy intake, intake of energy-containing nutrients (proteins,
carbohydrates and fats), alcohol intake, and intake of vitamins and
minerals, and also deficiencies.
Energy Intake and Mental Health
Energy refers to the calorie content of food. It is derived from carbohydrates,
protein, fat, and alcohol found in foods and beverages. The human brain is
metabolically very active and uses about 20-30% of a person’s energy intake
at rest. Individuals who do not eat adequate calories from food to meet their
energy requirements will experience in mental functioning. a hungry person
may also experience lack of energy or motivation.
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Chronic hunger and energy deprivation profoundly affects mood and
responsiveness. The body responds to energy deprivation by shitting or
slowing down nonessential functions, altering activity levels, hormonal
levels, oxygen and nutrient transport, the body’s ability to fight infection,
and many other bodily functions that directly or indirectly affect brain
function.
People with a consistently low energy intake often feel apathetic, sad, or
hopeless
Carbohydrates and Mental Health
Carbohydrates significantly affect mood and behavior. Eating a meal high in
carbohydrates triggers release of insulin in the body. Insulin helps let blood
sugar into cells where it can be used for energy. In addition, as insulin levels
rise, more tryptophan (an amino-acid) enters the brain. Tryptophan
affects levels of neurotransmitters in the brain especially serotonin. Higher
serotonin levels in the brain enhance mood and have a sedating effect,
promoting sleepiness.
Some researchers claim that a high sugar intake causes hyperactivity in
children.
Proteins and mental health
Protein intake and intake of individual amino-acids can affect brain
functioning and mental health. Many of the neurotransmitters in the brain
are made from amino-acids. The neurotransmitter dopamine is made from
the amino-acid tyrosine. The transmitter serotonin is made from tryptophan.
If the needed amino-acid is not available, levels of that particular
neurotransmitter in the brain will reduce and brain functioning and mood
will be affected. e.g. if there is lack of tryptophan in the body, not enough
serotonin will be produced, and low brain levels of serotonin are associated
with low mood and even aggression in some individuals.
On the other hand, some diseases can cause a buildup of certain amino-
acids in the blood, leading to brain damage and mental defects. E.g. a
buildup of the amino-acids phenylalanine in individuals with a disease
called phenylketonuria can cause brain damage and mental retardation.
Fats and Mental Health
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Dietary intake of fats may also play a role in regulating mood and brain
function. Although numerous studies clearly document the benefits of a
cholesterol-lowering diet for the reduction of heart disease risk, some
studies suggest that reducing fat and cholesterol in the diet may deplete
brain serotonin levels, causing mood changes, anger and aggressive
behavior.
High levels of fat and cholesterol in the diet contribute to atherosclerosis, or
clogging of arteries. Atherosclerosis can decrease blood flow to the brain,
imparing brain functioning. If blood flow to the brain is blocked, a stroke
occurs.
Alcohol and mental health
A high alcohol intake can interfere with normal sleep patterns and thus can
affect mood. a person who consumes large amounts large amounts of
alcohol will meet their energy needs but not their vitamin and mineral
needs. In addition, extra amounts of certain vitamins are needed to break
down alcohol on the body, further contributing to nutrient deficiencies
5.3 B Vitamins, central nervous system and behaviour

Vitamins are organic compounds essential for metabolism of other nutrients
and maintenance of a variety of physiological functions. The primary
function of vitamins is catalytic i.e. they serve as co-enzymes which facilitate
action of enzymes involved in essential metabolic reactions.
The common causes of nutrient deficiencies are:
 Inadequate intake
 High nutrient demand e.g. due to infections or physiological states such
as pregnancy
 Low bio-availability e.g. anti-nutrients such as tannins, phytates,
goitrogens, oxalates may affect bio-availability of some nutrients, the
cooking and preparation method may also impact on loss of nutrients
 Malabsorption
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Thiamin (vitamin B1)
It is a co-enzyme in metabolism of carbohydrates and branched chain amino
acids. It is also important for membranes functionality and conduction of
electric impulses. It is also involved in utilization and turnover of
neurotransmitters e.g. acetylcholine.
Alcohol consumption also contributes to thiamine deficiency because it
leads to degeneration of the intestinal wall thus impairing the absorption of
the vitamin.Wernicke-Korsakoff syndrome characterized by neurological and
psychological deficits may also be present in alcoholics due to thiamine
deficiency.
Since thiamine plays a role in energy metabolism at cellular level, its
deficiency may result into depletion of central glucose metabolism leading to
energy depletion and neuronal death.
The early stages of deficiency are featured by anorexia, weight loss, short
term memory loss, confusion, irritability, muscle weakness and enlarged
heart.
The common conditions from a deficiency of thiamine are:
 Dry beriberi (no edema) – which affects the nervous system and causes
damage to the nerves, decrease in muscle strength and muscle paralysis.
 Wet beriberi (edema is present) – which affects the cardiovascular
system.
Thiamine deficiency is associated with lesions in the brain particularly the
thalamus, hippocampus, brainstem and cerebellum. Damage to these parts
of the brain result in memory deficit and ataxia or loss of full control of
bodily movements.
Niacin (vitamin B3)
It is an important component of co-enzyme nicotinamide
adeninedinucleotide (NAD) which is important for intracellular respiration
and oxidation of fuel molecules such as lactate and pyruvate.
A deficiency in niacin causes neurological symptoms like dizziness,
sleepiness, irritability, loss of memory, confusion and emotional instability.
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In advanced cases it causes hallucinations, delusions, severe depression
and catatonia (abnormality of movement and behavior arising from
disturbed mental state).
Catatonia is a typical symptom of schizophrenia.
The condition that results from niacin deficiency is referred to as pellagra. It
is characterized by the four (4) D’s i.e. dermatitis, diarrhea, dementia and
death. It is particularly prevalent in populations that heavily rely on maize
as its staple food since the nicotinic acid in maize is in its bound form and
the body cannot utilize it much.
Signs of pellagra include:
 Fatigue
 Lack of appetite
 Muscular weakness
 Anxiety and irritability
Pyridoxine (vitamin B6)

It serves as a co-enzyme involved in the metabolism of protein and
carbohydrates, participates in the production of insulin, production of red
and white blood cells, synthesis of neurotransmitters and enzymes. A
deficiency results in dermatitis, microcytic anemia (formation of small and
immature red blood cells), convulsions, depression and confusion.
Supplementation with vitamin B6 is recommended to Tuberculosis patients
who are treated with isoniazid.
Cobalamin (vitamin B12)

It is significant in the functioning of the central nervous system and
formation of red blood cells. It is involved in metabolism of every cell in the
human body especially affecting DNA synthesis and therefore its deficiency
can potentially cause severe and irreversible damage to the central nervous
system.
At levels slightly lower than normal range, symptoms like fatigue, lethargy,
depression, poor memory, breathlessness, headaches and pale skin may be
present.
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Absorption of cobalamin requires intrinsic factor which is made by the
stomach. A few people have inherited a defect in the gene for intrinsic factor,
which results in abnormal absorption of cobalamin beginning in mid-
adulthood. Anemia resulting from lack of intrinsic factor is known as
pernicious anemia. Pernicious anemia causes fatigue, decreased tolerance to
exercise, shortness of breath and palpitations. Neurological signs of
deficiency are: tingling of hands and feet and poor motor coordination.
With continued deficiency, demyelination progresses gradually to include
damage to the spinal cord and eventually to the brain.
Cognitive changes include:
 Moodiness
 Loss of concentration
 Memory loss
 Confusion
 Depression
 Insomnia
 Dementia
 Visional disturbances
Folate (vitamin B9)

It is necessary in metabolism for energy production. It plays a significant
role in synthesizing proteins, genetic material, building muscles, making
new cells particularly the red blood cells, transmission of nerve signals. It
also prevents changes in the DNA.
Several studies have shown that patients with folate deficiency also have
psychiatric symptoms which include; irritability, paranoia and hostility.
Dietary deficiency of folic acid at the time of conception is also associated
with occurrence of spina bifida. Spina bifida is a developmental abnormality
of the nervous system. It is the congenital malformation of the embryonic
neural tube and spina cord.
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In addition these neural tube defects may be of genetic origin or due to
environmental factors e.g. irradiation and maternal infection (rubella).
5.4 Minerals, central nervous system and behaviour
Biological functions of minerals
 They are necessary constituents of a number of enzymes e.g. iron is
necessary for catalases and cytochromes, iodine is necessary for
production of thyroxin, calcium and phosphorus are important for bone
and teeth health.
 Minerals act as catalysts or co-factors for biological reactions e.g. the
absorption of nutrients in GIT and uptake of nutrients by cells.
 Minerals help to maintain acid-base balance in the body as well as to
regulate the physiology of cell membranes.
Iron
Iron deficiency anemia occurs in individuals with dietary inadequacies and
other health problems e.g. malaria, malabsorption and parasitic infections.
In children, IDA is strongly associated with impaired cognitive development
and intellectual performance.
The behavioural disturbances in both adults and children are:
 Irritability
 Mental fatigue
 Short attention span
 Impaired memory
 Anxiety
 Depression
Studies have shown that infants with iron deficiency tend to have poor
motor ability during the first two years of life. Additionally, developmental
test scores for these children are lower than those of non-anemic infant.
They also have behavior characteristic of ‘functional isolation’.
Functional isolation – limits infants’ stimulation and learning from the
environment because anemic infants are less likely to explore their
environment and are more likely to stay close to their caregivers.
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In school going children, iron deficiency results in poor academic
performance which may lead to anxiety, depression and social problems
especially since learners lag behind their peers on cognitive and motor
tasks.
Brain iron is involved in neurotransmitter metabolism and therefore has a
role in nerve conduction.
Iron is a cofactor for enzymes such as tyrosine hydroxylase and tryptophan
hydroxylase which are essential for the synthesis of dopamine and
serotonin.
Since dopamine is involved in perception, memory, motivation and motor
control, the behavioural symptoms of iron deficiency can be explained by
this connection. Many studies have shown that iron deficiency is
significantly associated with behavioural alteration.
Zinc
It is a mineral that is important for growth and development. It is widely
distributed in foods and is particularly important in protein metabolism in
tissues that undergo rapid turnover as well as in immunity.
Deficiency of zinc is associated with
 Growth retardation
 Behavioural abnormality
 Negative pregnancy outcomes
 Abnormal CNS development
 Attention is affected in zinc deficient infant
 Poor taste perception
Zinc deficiency results in infants are irreversible but the results are
reversible in adults.
Iodine
The thyroid hormone has multiple function as a regulator of cellular
metabolism and growth.
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Reduced metabolic rate is the principal biological consequence of iodine
deficiency.
Other manifestations are:
 Impaired physical growth and immaturation
 Slowness of movement
 Impaired reflexes
 Hoarseness of voice
 Skin changes
 Cardiac insufficiency
The symptoms of deficiency can be classified as mild, moderate or severe.
Moderate iodine deficiency: associated with reduced visual and motor
performance, perceptual abnormality and reduced intellectual capabilities.
Severe iodine deficiency: during infant development stage, both physical and
mental abnormalities are manifested e.g. in neurological cretinism, mental
retardation, poor display of spastic movement and gait as well as deaf and
mute situations are reported. These are irreversible.
Iodine deficiency can be avoided by fortification of salt with iodine.
In conclusion, intake of essential minerals is important for normal brain

development and functioning. In adults, mineral deficiency can lead to a
variety of alteration in behavior, unfortunately, the consequences of mineral
deficiency are most often irreversible if they occur during s critical stage of
brain development.
Iodine and zinc deficiency during fetal development can lead to permanent
impairment of brain function and behavior.
5.5 Summary
 Vitamins and minerals play a significant role in the functioning role of
the nervous system and behaviour
 Vitamin deficiencies can result in neurological and psychological
problems e.g. sensory or motor functioning.
Research on Wernicke- Korsakoff syndrome
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UNIT 6: EFFECTS OF CHRONIC AND ACUTE FORMS OF MALNUTRITION
6.1 Objectives
 To highlight protein energy malnutrition
 To explain the short-term effects of nutrition and behaviour malnutrition
6.2 Protein energy malnutrition
It is the most common form of malnutrition. It can occur as Marasmus,
kwashiorkor or Marasmic-kwashiokor.
Marasmus results from insufficient energy intake, that is, an extremely low
intake of both protein and calories. It is most often observed in infants
under 1 year of age at the time of weaning. However, in developed countries
a form of it can strike young women who have dieted excessively, as in
anorexia as well as the elderly poor who have difficulty in obtaining or
ingesting sufficient calories.
Kwashiorkor results from the insufficient intake of protein and it is most
likely to occur in the second or third year of life, when a baby is weaned. It
typically develops when the toddler is from 18 to 24 months of age, weaned
from the breast and fed the high carbohydrate-low protein diet. The
behavioural characteristics of kwashiorkor is a lessened interest in the
environment, along with irritability, apathy and frequently anorexia. But
most notably, the toddler with kwashiorkor cries easily and often displays
an expression of sadness and misery
Marasmic kwashiorkor often exhibit symptoms of both marasmus and
kwashiokor conditions or alternately display one and then the other
Iatrogenic PEM is an adult from of PEM. It characterizes the individual
whose nutritional status deteriorates after prolonged hospitalization, when
hospitalization is not due to a dietary or gastrointestinal problem.
Comparison of different forms of PEM
Feature Marasmus Kwashiokor Iatrogenic PEM
Type of victim Infants, elderly Toddlers Hospitalised
poor adults
Growth failure severe Somewhat N/A
severe
Muscle changes Wasting Wasting Weakness
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Subcutaneous fat absent Present Decreased
Edema Absent Always Absent
Skin Changes Rare Frequent Capillary fragility
Hair changes Frequent Very frequent Frequent
Liver enlargement Rare Frequent Rare
Diarrhea Frequent Frequent Frequent
Blood changes Frequent Anemia Low lymphocyte
anemic count
Serum albumin Normal Low Low
Appetite Ravenous Anoretic Anoretic
Irritability Always Always Frequent
Apathy Always Always Apathy towards
eating
Other psychological Failure to thrive Whimpering Altered taste
features cry sensation
PEM, Brain Development and Behavior

Nutrition plays an important role in brain development, affecting the growth
and number of neurons, the development of synapses and myelination of
axons, the production of neurotransmitters etc
PEM and early Human Development
Severe malnutrition and food deprivation can conceivably reduce fertility
although chronic poverty tends to be associated with large families. From a
behavioural perspective, both men and women may have little interest in sex
during times of starvation.
Biologically, women may develop amenorrhea, while men may loose their
ability to produce viable sperms. In fact, women who diet excessively to the
point of anorexia suffer from malnutrition and are neither interested in, nor
capable of becoming pregnant.
If a malnourished woman becomes pregnant, she must face the challenge of
supporting both the growth of the fetus and her own physical health with
less than sufficient nutrient stores.
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Severe PEM early in development will result typically in failure to maintain
embryonic implantation, resulting in a spontaneous abortion.
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Short term effects of nutrition and behaviour
6.3.1 Malnutrition effect cycle
Malnutrition leads to brain damage, brain damage leads to lowered IQ and
low IQ leads to impaired behavior. This is best demonstrated using the
diagram below.
The PEM-Behavior Cycle
Severe protein malnutrition in early development results in failure to

maintain embryonic implantation resulting in
abortion.Moderate acute malnutrition throughout pregnancy may permit
spontaneous
continued development of the fetus but will lead to changes in growth of

both the placenta and the fetus. If the placenta is poorly developed, it
cannot deliver adequate nourishment to the fetus and the infant may even
be born prematurely, small for their gestation age and with reduced head
circumference.Small head circumference is a clear
marasmus develops at young ages compared to kwashiorkor, a marasmic

indication
malnutrition has occurred and results in permanent head damage. Since
child is more likely to have reduced head circumference than that with
kwashiorkor.
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that
Post-natal brain has its development impaired in those cells and regions
that show maximum growth at the time of nutrition deficiency. Therefore,
postnatal malnutrition is usually associated with reduction in the number of
glial cells and not neurons. Glialcells regulate homeostasis by offering
support and protection to the functioning of neurons. Neurons on the other
hand transmit signals between themselves and from one part of the body to
another.
In adulthood, malnutrition impairs biological functions related to the
reproductive system. In men, the ability to produce viable sperm is affected
and in women, amenorrhea occurs and may result in infertility.
If a malnourished woman gets pregnant, the pregnancy outcome is
unfavorable i.e. spontaneous abortion may occur or they may give birth to
infants with congenital malformations.
6.3.2 Behavioural Effects of Severe Malnutrition
Lower IQ scores and school performance has been reported in impoverished
children who experienced early clinical malnutrition.
Behavioural symptoms of marasmus include irritability and apathy. Those
of kwashiorkor include anorexia and withdrawal, whimpering and
monotonous cry.
Lethargy and reduced activity are the most commonly observed in the two
forms. This reduced motor activity may help to isolate malnourished infants
from their environment, resulting in limited opportunities for learning and
thereby depressing mental development. Malnourished newborns may be
poor in their taste organisation, low in social responsiveness and not very
adapt at orienting to visual stimuli.
Although apathy and reduced activity are characteristics of malnourished
infants, many behaviors of infants failing to thrive cannot be attributed to
malnutrition alone. Instead, the infant’s irritability may discourage social
interactions, which the mother may be interpreted as personal rejection.
6.3.3 Effects on children and adults
Cognitive deficits
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Severe malnutrition before three years of age leads to low IQs (below 70)
even after two or more years of recovery. Malnutrition may have been
confounded with poor parenting (e.g. mothers being less sensitive, verbally
communicative, emotionally involved or interested in their child’s
performance relative to their behavior with the unaffected child).
Motor delays
Motor skills are delayed in children with PEM, although this is not always
the case. School age children who are only mildly undernourished can have
their activity level reduced. High activity positively correlates with protein-
calorie intake and vice-versa.
Behavioural problems
A study done among Kenyan children found that energy intake was
positively associated with observed happiness and leadership, and was
negatively associated with observed anxiety.
Formerly malnourished children show less emotional control, are more
distractible, have lower emotional spans, and develop poorer relationships
with their peers and their teachers.
Food insecure families have children who are rated as higher in
hyperactivity and other problematic behaviours.
Despite cultural differences in expectations for behavior, malnourished
children generally seem to have more behavioural problems than normal
children e.g. being aggressive and hyperactive at ages eight and eleven, and
higher in conduct disorders and excessive motor activity at age seventeen.
School performance
Those who were malnourished during infancy tends to earn poor grades
than matched controls (those who were well nourished then), although it is
not obvious.
NB: there has not been much research conducted on school-age children
with respect to long-term effects of malnutrition on their school
performance.
Effects in Adults
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Adolescents from low-income households that experience food insufficiency
report higher levels mild depression, suggesting that persistent food
deprivations may affect mental health.
Lethargy and reduced activity are also observed. Apathy, social isolation and
impairments in memory also occur.
Decreases in activity, motivation, self discipline, sex drive and mental
alertness with increase in apathy, irritability and moodiness are also
common.
6.4 Summary
 Malnutrition has adverse behavioural consequence

1 Discuss acute and chronic forms of malnutrition
UNIT 7: DIETARY SUPPLEMENTS, MENTAL PERFORMANCE AND
BEHAVIOUR
7.1 Objectives
 To define dietary supplements
 To explain the relationship between dietary supplements and cognition
7.2 Dietary supplements and cognition
According to the US Dietary Supplement Health and Education Act (DSHEA)
of 1994, the term dietary supplement refers to a product (other than
tobacco) that is intended to supplement the diet that bears or contains one
or more of the following ingredients; vitamins, minerals, amino acids, herbs
or other botanical and dietary substance for use by man to supplement the
diet by increasing total dietary intake e.g. enzyme or concentrate, a
metabolite a constituent or an extract.
It is intended for ingestion in the form of pills, capsules, gels, tablets or
powders and is not recommended for use as conventional food or as sole
item of meal or diet.
Under DSHEA, it is the manufacturer who is responsible for determining
that its supplements are safe and that claims made about them are
supported by scientific evidence that is not false or misleading. Dietary
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supplements are marketed as food and therefore their regulation has not
been developed. These products cannot be removed from the market unless
there is evidence that they can cause harm to the public.
The public perceives these products as ‘natural’ and healthy and therefore
without health risks. However, some products can have side effects or can
interfere with action of other medication. Interactions between medicinal
herbs and common medications can pose serious health problems. For
instance, consuming Gingko biloba with anticoagulants, vitamin E or even
aspirin can cause internal bleeding
The long-term use of these products is leads to effects that are largely
unknown as they are not subjected to the rigorous safety standards that
apply to the manufacture and sale of pharmaceuticals.
There are several clinical studies conducted on dietary supplements but the
bulk of this is flawed by the use of inappropriate study designs. Clinical
studies should be randomized, placebo-controlled, double-blind trial.
Dietary supplements are one of the most common forms of Complementary
and Alternative Medicine (CAM) that patients use.
7.2.1 Examples of supplements with beneficial health claims
Vitamin E
Vitamin E is a fat-soluble vitamin that primarily functions as chain-breaking
antioxidant in lipids. Vitamin E prevents the propagation of free-radical
reactions. Specifically, the vitamin protects polyunsaturated fatty acids from
attack by peroxyl radicals. This protection derives from the fact that peroxyl
radicals react 1000 times more rapidly with vitamin E than with PUFAs.
Vitamin E deficiency is extremely rare in humans and is only associated
with malabsorption of the vitamin (as in cystic fibrosis) or inborn errors in
vitamin E metabolism. Vitamin E supplements are sold as esters (to protect
the shelf life) of the natural form or as the synthetic mixture. When α
tocopherol is derived from vegetable oils it is labelled as a natural source of
vitamin E.
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There are few adverse effects of consuming large doses of α-tocopherol as
dietary supplements. High doses of the vitamin lead to hemorrhage in
experimental animals, but large studies in humans showed no evidence of
hemorrhagic stroke.
Vitamin C
Vitamin C is a broad-based, water-soluble antioxidant that quenches a
variety of reactive oxygen and nitrogen species. In addition to its own
antioxidant activity, Vitamin C can also regenerate or spare α-tocopherol.
When α-tocopherol intercepts a radical, a tocopheroxyl radical is formed.
This radical can be reduced by vitamin C (or other reducing agents), thereby
oxidizing vitamin C and returning vitamin E to its reduced state. Thus,
vitamin C has the capacity to recycle vitamin E.
Vitamin C is also highly concentrated in the central nervous system (CNS)
and local brain concentrations change rapidly with neuronal activity.
Moreover, brain pools are relatively resistant to vitamin C depletion.
Together, these observations suggest a major role for vitamin C in CNS
functioning. The protective effects of vitamin C in the brain may arise from
its free-radical scavenging ability.
In the periphery, vitamin C has vasodilatory and anti-clotting effects, and is
thought to play a role in the reduction of cardiovascular disease by
inhibiting plasma low-density lipoproteins (LDL) cholesterol oxidation.
Oxidized LDL tends to aggregate on vascular cell walls resulting in the
accumulation of plaques that narrow blood vessels. Since senile dementia
and other neurodegenerative diseases may involve narrowing of cerebral
blood vessels, vitamin C may serve similar functions in the brain.
Dietary supplements containing vitamin C are popular, but estimated
intakes from both food and supplements rarely exceed 200 mg/day.
Although serious risk of adverse effects from excess vitamin C intake from
food and supplements is low, some individuals experience gastrointestinal
disturbances such as nausea, cramps and diarrhea from large oral doses.
The UL for vitamin C for adults is 2000 mg/day.
Beta-carotene
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Although consumption of β-carotene and other carotenoids has been linked
to reduced risk of chronic diseases such as cancer and cardiovascular
disease, these effects have not been firmly established. It is however believed
to be an emulsifier and therefore stabilizes the lipid profile At present, there
is no dietary reference intake for carotenoids, per se since the biological
functions of these compounds are diverse and are poorly understood.
However, several carotenoids including α-carotene, βcarotene and β-
crytoxanthin have well-known pro-vitamin A activity.
β-carotene from supplements has a much higher bioavailability than from
foods. This is because the β-carotene from supplements is not bound to
proteins and has been solubilized with emulsifiers. There are no health risks
from consuming large amounts of carotenoids from foods or supplements
except for carotenoiderma, a yellow discoloration of the skin that is not
harmful. No upper limit has been set for β-carotene or other carotenoids.
Selenium
Selenium principally functions as selenoproteins. Two classes of
selenoproteins are known.
i. glutathioneperoxidase enzymes whichserve as the body’s primary
defense mechanism against oxidative Glutathione peroxidase is widely
distributed in the body but is highly concentrated in the brain where
it is localized in glial cells in central gray matter, hippocampus and
temporal cortex. Decreased activity of this enzyme has been
documented in patients with Alzheimer’s and Parkinson’s disease
which could imply a general increased level of oxidative stress in these
individuals.
ii. iodothyronine deiodinases regulate thyroid-hormone metabolism.
These enzymes play a role in iodine deficiency disease and cretinism.
Many dietary supplements also contain selenium. However, the risk to
the general population of adverse effects from high doses appears to
be low. The UL for selenium is 400 µg/day
Vitamins B6, B9 and B12
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Elevated homocystein levels have been associated with an increased risk of
dementia. The most common causes of homocyteine elevation are
deficiencies in Vitamins B6, B9 and B12. Therefore, enhanced homocysteine
metabolism through B-supplementation may have a beneficial effect on
reducing risk of dementia.
 Vitamin B6 is an essential cofactor in homocysteine metabolism
 Vitamin B9 acts as a donor of methyl groups for the methylation of
homocysteine to methionine
 Vitamin B12 is also required in the methylation of homocysteine to
methionine.
Essential fatty acids
The mechanisms for their benefit in cognition and dementia include
reduction in cardiovascular diseases and stroke, reduction in synthesis of
pro-inflammatory cytokines implicated in the development, maintenance of
brain cell membrane integrity and neural function.
7.3 Herbal supplements and behaviour
Ginkgo biloba
It is an herb derived from the leaves and nuts of the ginkgo or maidenhair
tree. It has been used to treat asthma and chilblains (sores of the hands and
feet from exposure to the cold) in Chinese medicine for thousands of years.
Pharmacological studies suggest that this herb has anti-edemic,
antihypoxic, free radical scavenging, antioxidant and anticoagulant activity.
Ginkgo has been used experimentally to protect against myocardial
reperfusion injury, depression, brain trauma, memory impairment,
dementia and intermittent claudation. Extracts contain the active
ingredients, flavonoid glycosides and terpene lactones.
NB: despite the theoretical basis of ginkgo biloba in the prevention of
cognitive decline, there is no convincing evidence that it’s efficient in
preventing dementia of delaying cognitive decline among older adults.
Ginseng
The roots of Asian ginseng (Panax ginseng) are believed to have sedative,
hypnotic and antidepressant properties. Ginseng extract also acts as a CNS
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stimulant and potentiates the stimulatory effects of caffeine from coffee, tea
and cola. The herb is used in traditional Chinese medicine to improve
cognitive performance, vigilance, stamina and concentration.
It has been investigated as a therapeutic agent for improving cognitive
performance, memory and mood.
Side effects include insomnia, nausea, diarrhea and headache. It also lowers
blood glucose. Thus, the use of this herb might be counterindicated in
individuals taking anti-diabetic medications. Ginseng is also reported to
interact with monoamine oxidase (MAO) inhibitors, used in the treatment of
depression, and anticoagulants such as warfarin.
St. John’s Wort (Hypericum perforatum)
It is a wild-growing herb with yellow flowers. It has been used since ancient
times to treat mental disorders and nerve pain. When applied topically as a
balm, it was used to treat insect bites, wounds and burns. Currently it is
used primarily to treat mild to moderate depression. However, it is not
effective in treating major depression. The main active constituents of SJW
(St. John’s Wort) are hypericin and hyperforin, although other components
may be active as well. More research needs to be done to determine precisely
how SJW counteracts depression.
St. John’s Wort has fewer side effects than conventional antidepressants
which make it an attractive treatment alternative. Side effects may include a
dry mouth, dizziness, gastrointestinal effects, increased sensitivity to light
and fatigue.
It adversely reacts with medication; SJW rapidly deactivates several classes
of drugs by inducing liver detoxifying enzymes. Serious interactions are
known to occur with protease inhibitors used to treat HIV infection,
immunosuppressant drugs, birth control pills, cholesterol lowering drugs,
cancer and antiseizure medications and blood anticoagulants therefore SJW
should not be combined with other medications.
Kava
Kava is made from the dried rhizome of the plant Piper methysticum and
was traditionally used as a recreational drink in the South Pacific. Kava has
anxiolytic properties and also acts as a muscle relaxant, mood enhancer,
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analgesic and sedative. It is generally used to treat seizures and psychotic
illnesses. The active compounds are a family of kavapyrones, the anxiolytic
actions of which are complex.
Kava should be avoided in individuals taking psychotrophic medications.
Long-term use has been associated with yellow discoloration of the skin,
hair and nails, visual disturbances, dizziness, ataxia, hair loss, hearing loss,
appetite loss and weight loss. It severe cases it may induce toxic liver
damage.
Oxidative damage in the CNS
The brain has high energy needs and has a high rate of oxygen utilization
which makes it highly susceptible to oxidative damage.
It also has high content of fatty acid incorporated into neuronal membrane
and much of it are unsaturated fatty acids that are vulnerable to oxidation.
Oxidative damage to the brain cells result in occurrence of disease like
Alzheimer’s disease and Parkinson disease.
1. Alzheimer’s disease
It is the most common form of dementia. There is continuous atrophy of the
cerebral cortex accompanied by deteriorating mental functioning e.g.
reasoning.
The etiology is unknown. However, genetic factors may be involved. Females
are affected twice as often as males and it usually affects those over 60
years of age.
Alzheimer’s disease and deficits associated with it
o Cognitive - Forgetfulness, loss of memory, memory distortions. Deficits
in concentration, attention, learning and problem solving. Language
deficits and the ability to draw figures
o Functional – loss of motor skills including the ability to walk and talk,
incontinence, emergence of primitive reflexes such as grasping and
sucking
o Behavioural – mood swings, apathy, depression, irritability,
restlessness. Delusions and hallucinations
2. Parkinson’s disease
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It is a disease in which there is gradual degeneration of dopamine-releasing
neurons in the extrapyramidal system.This results to lack of control and
coordination of muscle movement leading in fixed muscle tone and muscle
tremor of extremities.The cause is unknown but some cases are associated
with repeated trauma.Onset is usually between 45 and 60 years.
There is progressive physical disability but intellect is not impaired.
7.4 Summary
1. Define oxidative stress
2. State the meaning of selenoproteins
3. Discuss oxidative stress and dietary antioxidants
4. Read more on Alzheimer’s and Parkinson’s disease
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UNIT 8: BI-BEHAVIOURAL AND PSYCHOLOGICAL INFLUENCE ON
NUTRITION
8.1 Objectives
1. To explain bi-behavioural and psychosocial influence on nutrition
2. To outline psychosocial health and psychosocial determinants
8.2 Bi-behavioural influence on nutrition
The effect of nutrition on behavior is bidirectional. On one hand, nutritional
state can have a profound effect on our mental state, the state of our well-
being and our responses to physical and emotional stress.On the other
hand, certain aspects of our social or physical environment such as cultural
and family background, where we live and our educational and income level
affect our attitudes towards foods. This combination of social and
environmental variables can have several consequences for eating behavior,
mediating both the types and amounts of foods we choose to consume,
ultimately influencing nutritional state.
Therefore, bio-behavioural and psychological influence on nutrition explores

how major biological variables like sex, age, genetic background and disease
influence nutrition- behavior paradigm/ pattern. Certain variables such as
the presence of disease can directly alter nutritional state hence influence
eating behavior. On the other hand, other variables such as genetic
variation in taste do not affect nutritional state directly, but exert a strong
influence on eating behavior which subsequently influences nutrition and
health.
Social and environmental variables (psychosocial variables) can operate in a
similar manner. Psychosocial variables can mediate or modify behaviours
which have a subsequent effect on nutritional state.
Age
Sex
Genetics
Nutrition Disease
Behavior
Psychosocial
factors
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In free- living humans, it is extremely difficult if not impossible to isolate the
effects of a single variable on behavior because of confounding variables.
8.2.1 Genetic and Biological Determinants of Nutrition- Behavior
Paradigm
Taste perception and preference
Taste is the most important determinant of food choices. It encompasses
several of food dimensions such as aroma, flavour and texture.
Aromas and flavours are complex mixtures of volatile odour compounds.
Taste buds respond to the four classic basic tastes including sweet, salt,
bitter and sour.
Oral irritation, touch, temperature and pain represent a broadly defined
class of sensation that are associated with free nerve endings of the
trigeminal nerve and specialized receptors of somato-sensory fibers.
Trigeminal sensations include, for example, the hotness of chilli peppers and
coolness of mint. Texture relates to the feel of the food and the mouth (e.g.
grainy, lumpy, oily etc) and its mechanical properties i.e. how it responds to
the forces in the mouth during chewing e.g. hardness.
Flavour learning in the uterus has also been shown to influence post-natal
food ingestion. In addition, early flavour experiences, both in the womb and
during lactation, increase a child’s familiarity with flavours and facilitates
the learning of cuisine. These early experiences may have long-term
consequences for food selection later in development.
Neophobia and familial interactions

Food selection by young children is strongly determined by familiarity with
and exposure to specific foods.
Since the consumption of a varied diet is consistent with good health,
repeated exposure to new foods during childhood could promote diversity in
children’s food choices and ultimately lead to the selection of healthiest
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diets. Studies have shown that children can overcome neophobia with
repeated exposure to the taste of a novel food
Since young children have little control over the types and amounts of foods
served to them, parental feeding practices play a critical role in shaping a
child’s eating environment.
In addition, parents (particularly mothers) also communicate their own
attitudes about food and eating to their children. For example, a certain
study showed that mothers who were overweight themselves had daughters
who overate and were heavier.
NB: parents and children also share not only a common eating environment
but a common genetic background.
Genetic variation in Taste and Food Selection

Humans show large individual variation in preferences alone. There are
those individuals regarded as ‘tasters’ (about 70%) who experience moderate
and extreme bitterness of some food compounds; and ‘non-tasters’ (about
30%) who experience no taste to such compounds.
The liking of fruits and vegetables is influenced by a variety of factors
including attitudes, social norms and health considerations. Current dietary
recommendations encourage the consumptions of fruits and vegetables
which are rich sources of cancer preventive phytochemicals and
antioxidants. Many of these compounds are however bitter-tasting hence
disadvantaging the ‘tasters’.
Both ‘tasters’ and ‘non-tasters’ are anatomically different. Tasters have more
taste buds on the tip of the tongue hence their greater sensitivity to basic
taste sensations. They also have more trigeminal fibers, which play a role in
perception of fats and irritation.
Most studies have shown that tasters show lower acceptance of many foods
that have the key sensory qualities including high fat salad dressings and
dairy products than non-tasters.
NB: genetic taste differences might pre-dispose an individual to either like or
dislike chilli peppers. Non-tasters tend to take more fatty foods than tasters
which would lead to higher body weights overtime.
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8.2.2 Disease, Aging and Other Physiological Differences
Disease
A variety of systemic diseases can influence food and fluid appetite. Aging
may reduce the quality of life e.g. aromas are 2-15 times harder for elderly
to detect, and when detected, they are weaker to them than the young. Age
decline in taste perception is much more modest than for aroma perception
NB: All taste qualities are not equally affected
Aging
The elderly are more likely to experience a decline in bitter taste than in
sweet taste; decreased sour and salty taste has been reported in some
studies on aging but not others.
Diminished appetite may be a risk factor for weight loss, poor nutritional
status and other health consequences in genetic population.
The sources of appetite changes in the elderly are many but can be grouped
into three major categories:
 Functional changes to the taste/ smell system- the causes of taste/
smell loss include reduction in the number or activity of taste buds or
olfactory receptors, changes in conduction along nerve pathways, or
reduced activity at higher brain centers.
 Physiological changes associated with the diseases of aging and their
treatment
 Demographic/ psychosocial factors
Other changes associated with the aging process include dry mouth and
changes in dentition which affects the ability to chew and swallow food, and
also functional changes in the GIT that affect absorption and utilisation of
nutrients.
Pregnancy
Appetite changes are common in pregnancy and are generally of two types:
a. Food aversions- usually experienced during early stages of gestation
b. Food cravings- usually experienced later in gestation
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Food aversions are closely associated with nausea and vomiting. Commonly
associated foods are salty and spicy foods (including meats and shell fish),
alcohol and coffee. The coffee and alcohol are of particular concern because
of their toxic effects that increase the risk of miscarriages and still births.
Some researchers however show that the steep rise of gestational
hormones is responsible for the nausea and vomiting hence the two
theories are not clear.
On the other hand, cravings tend to appear more frequently and intensely
during mid-pregnancy and to decline thereafter. Generally, sweet foods are
preferred in mid-pregnancy, whereas spicy and salty foods are preferred late
in pregnancy.
Researchers have also questioned whether changes in food cravings can be
linked to fluctuations in gestations hormones. These hormones begin to rise
in early pregnancy and reach a peak at mid-pregnancy before falling
towards baseline at delivery.
These hormones are associated with metabolic adaptations that ensure a
constant flow of energy to the developing fetus primarily in the form of
glucose.
8.2.3 Ethnicity/ Culture/ Social Interactions
Introduction- social norms, attitudes and beliefs are critical determinants
of food selection within a culture. Every culture has food traditions which
are passed down from generation to generation. Such traditions determine
which foods to be eaten or avoided, what foods to be eaten together or within
certain social contexts etc.
a complex code of rituals surrounds the preparation, presentation and
consumption of foods. Some foods are avoided only during religious
observations e.g. avoidance of meat during Lent of Ramadan.
Children learn what foods are appropriate to consume and when to consume
them.
Cuisine
Cuisine refers to methods of food preparation and presentation that express
the aesthetic, gustatory, social and nutritional ideals of a people or culture.
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All people cook their food unlike animals. To a large extent, cooking and
transforming food has practical significance for releasing nutrients from the
food has practical significance for releasing nutrients from the food. e.g.
cooking legumes disables protease inhibitors and lectins that lower their
digestibility.
Cuisine varies greatly around the globe. However, there are three universal
components of cuisine: dietary staple, cooking techniques, flavour principles
e.g.
o Dietary staples: maize- Mexico, rice- Asia
o Cooking techniques- Stir-fry- Asia, stewing- Mexico
o Flavour Principles: - Greece- Lemon, oregano, olive oil
- Indonesia- soy sauce, coconut, chilli, groundnuts
- China- soy sauce, ginger, garlic, sesame oil
- Italy- tomato, oregano, garlic, olive oil
Food plays an important role in life, as a source of pleasure, health and

personal identity. However, attitudes towards foods door vary cross-
culturally e.g. in a study to compare the food attitudes of French, Belgium,
Japanese and US consumers, French were found to view foods in terms of
cuisine and pleasure whereas Americans were most influenced by
nutritional value and health risks.
8.2.4 Eating attitudes
Nutritional Attitudes and Beliefs
An Individual’s behavioural intention is mainly determined by two
components:
The individual’s own attitude (whether the individual perceives the behavior
to be good or beneficial)
The subjective norm (the perceived social pressure to behave in a certain
way)
This is explained by the Fishbein- Ajzen theory of reasoned action which has
been useful in capturing the effects of attitudes and beliefs on food selection.
It has been useful for predicting the selection (avoidance) of high- fat foods
including milk and meat.
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The model has also helped understand other types of consume behavior
such as consumption of organ products, attitudes towards pesticides and
genetically engineered foods.
Food Avoidance and Rejection

There are three major elements of food rejections: distaste, danger, disgust-
relates to the contamination of a food through contact with offensive
substance such as insects or hair. It also includes socio-cultural reasons for
rejecting food e.g. ethical implications related to the environmental and
human rights.
Gender Differences
It is unclear whether gender differences in eating behavior reflect the
biological variability or socio-cultural differences in eating attitudes.
Food preferences of men and women differ with women preferring vegetables
and sweets and men preferring meats.
Men and women tend to avoid different foods for different reasons. Men
avoidance is usually stronger than women. Women tend to avoid other foods
due to weight concerns. Overall, women’s food choices appear to be more
strongly motivated by health/ nutritional beliefs than those of men.
For the young people (particularly college students), concerns about physical
appearance is a dominant theme. The issue is also perceived differently by
both genders with women wanting to lose weight. Adolescents tend to have
more weight dissatisfactions hence more use of weight control behaviours;
more symptoms of disordered eating among vegetarians than non-
vegetarians.
Cost/ Convenience/ Availability of Food

Eating out has increased over time accompanied by its cost. Foods eaten
away from home are generally higher in energy content and portion sizes
have also increased substantially.
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Consumer demand for convenience continues to escalate and convenience
foods represent a major area of growth and innovations for the food
industry- there is a range of meal options in the market.
Cost is an important consideration for food purchases across all socio-
economic groups. Low-income groups are at greater risk for inadequate
nutrition than their affluent counterparts with infants and children,
pregnant and elderly being most vulnerable.
The consumption of fruits and vegetables and dairy products is lower in low-
income households and has been linked to lower intakes of several nutrients
including vitamins C, A, B-6, folate, zinc, iron and calcium. Persons living in
poverty may not have the financial resources to afford a healthy diet. Low
intakes of vitamin B-6, folate, zinc and iron have different effects on
behavior.
Dietary Restraint and Disinhibition

Dietary restraint is defined as the conscious control of food intake to lose
weight or maintain current weight.
The concept of dietary restraint arose from early theorists in an attempt to
understand the distinction between the eating patterns of obese and normal
weight individuals
Theories of time suggested that overeating in obese was due to over-
responsiveness to external cues like food palatability and under-
responsiveness to internal physiologic hunger-satiety signals. it was also
thought that obese individuals were biologically programmed to maintain a
higher body weight ‘set-point’ than normal weight individuals hence by
dieting, many obese individual were artificially suppressing their body
weight under their biologically- defending set-point.
Therefore this behavior would inevitably lead to overeating, precipitating a
vicious cycle of weight loss and regain.
As a result some scientists developed the ‘boundary’ model to describe the
effects of dieting on eating. The model was eventually applied to normal
weight dieters as well.
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The Boundary Model of Eating
According to the model, food intake is regulated along a continuum ranging
from hunger to fullness. In the continuum, biological processes drive food
consumption. On one hand, energy depletion gives rise to sensations of
hunger and on the other, energy excess gives rise to sensations of
discomfort.
The hunger and satiety boundaries represent the points at which eating is
either initiated or terminated. In between these two is the ‘zone of biological
indifference’ which reflects an interim state of neither extreme hunger nor
extreme fullness where cognitive and social factors control food intake.
8.3 Psychosocial health and psychosocial determinants
Psychosocial means something relates to one's psychological development
in a social environment and interaction with a social environment. It relates
social condition to mental health
Basic Traits of Psychosocial Health
Individuals who are deemed to be psychosocially healthy aren't completely

devoid of problems. Actually, it is not the quantity or quality of a problem, or
lack thereof, which makes someone sound in this respect. It is the way
people view themselves and how they deal with stressful situations that
distinguishes psychosocially healthy people from those who are not.
Psychologically healthy individuals possess the following traits:
 They like themselves
 They accept their mistakes
 They take care of themselves
 They have empathy for others
 They control their anger, hate, tension, and anxiety
 They are optimistic
 They can work alone and with others equally well
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Mental Health
The thinking portion of psychosocial health is known as mental health.

Your beliefs and values in life, as well as how you relate to others and
respond to situations in your life, are a reflection of mental health, which
overlaps with the other aspect of health. When something happens to you
that you don't like and you respond in a positive manner by accepting your
mistake and looking forward to its correction, then that is good and healthy.
Emotional Health
The feeling part of psychosocial health is called emotional health. This

includes things like anger, love, hate, and happiness. Everyone, even the
most optimistic people, have their ups and downs. But an emotionally
unhealthy person is one that responds to a situation in a manner that is
uncontrollable, out of proportion, and extreme.
Emotional intelligence is also an important aspect of psychosocial health.

It is the ability to understand and manage your emotions and those of
others. It can be broken up into five main parts:
 Know your emotions: Are you able to quickly recognize your feelings?
 Manage your emotions: Can you express those feeling appropriately? Are
you able to cope with them well?
 Motivate yourself: The more you can do this independently in order to
achieve more in your life, the higher your emotional intelligence.
 Recognize the emotions of others: The more you can empathize with others,
the better.
 Handle your relationships: The better you are at navigating conflict in life
and building a good social network, the higher your emotional intelligence.
Social Health
This refers to the ability to create and maintain healthy relationships with
others.
Social health goes beyond having appropriate emotional health and
intelligence. A person with good social health:
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 Recognizes the importance of social engagement. We are not supposed to
live alone
 A person with good social health is able to support their friends in a time of
need and ask for their help when they need it themselves.
 They are not biased, prejudiced, racist, or sexist.
 Listens to others well, expresses their feelings just as well, and acts in a
responsible manner around others.
As an example of a person with good social health is someone who has close
friends that they enjoy listening to and feels close enough to share
important feelings with.
Spiritual Health
The final aspect of psychosocial health is spiritual health, a belief in a force

that gives meaning to life. For some, it is nature or something else that is
bigger than them. Regardless of where a person's ethics, morals, values, and
beliefs come from, they should give them a sense of purpose, awareness,
and community.
Psychological Determinants of Nutrition
Stress
Psychological stress is a common feature of modern life and can modify

behaviors that affect health such as physical activity, smoking or food
choice. The influence of stress on food choice is complex because of the
various types of stress that one can experience. The effect of stress on food
intake depends on the individual, the stressor and the circumstances.
Generally, some people eat more and some eat less than normal when
experiencing stress.
The proposed mechanisms for stress induced changes in eating and food
choice are motivational differences (reduced concern about weight control),
physiological (reduced appetite) caused by the processes associated with
stress) and practical changes in eating opportunities, food availability and
meal preparation.
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Studies also suggest that if work stress is prolonged or frequent, then
adverse dietary changes could result, increasing the possibility of weight
and consequently cardiovascular risk.
Mood and emotions
Mood and emotions could influence food choice via physiological effects that
change appetite, or by changing other behavior that constrains or alters food
availability.
Moods have been distinguished from emotions in that emotions can be
defined as short-term effective responses to appraisal of particular stimuli,
situations or events having reinforcing potential, whereas moods may
appear and persist in the absence of stimuli. Mood is typically characterized
as a psychological arousal state lasting at least several minutes and usually
longer
Foodinfluences mood and mood has a strong influence over our choice of
food.
It appears that the influence of food on mood is partially related to attitudes
towards particular foods. The ambivalent relationship with food- wanting to
enjoy it but conscious of weight gain is a struggle experienced by many.
Attempts to restrict intake of certain foods can increase the desire for
particular foods, leading to food cravings. Women more commonly report
food cravings than do men. Food cravings are also more common in the
premenstrual phase, a time when food intake increases and corresponding
basal metabolic rate occurs. Depressed mood appears to influence the
severity of these cravings.
8.4 Summary
All the factors discussed in this unit represent the multidisciplinary nature
of the Nutrition-Behavior Paradigm. There is no single theory or factor that
can completely explain what is eaten, how it is eaten or why food selection
and eating remain a complex and highly personal human behavior.

Further reading on the nutrition behaviour paradigm
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UNIT 9: STIMULANTS, DEPRESSANTS, SWEETNERS AND FOOD
ADDICTIVES
9.1 Objectives
 To define dietary sugar and behaviour
 To explain the interaction between caffeine, methylxanthines and
behaviour
 To highlight food addictives
9.2 Dietary sugar and behaviour
Sugar belongs to a group of foods known as carbohydrates that are
composed of the elements carbon, Hydrogen and oxygen. Carbohydrates, in
human nutrition are classified as sugars, starches and fibres.
Food manufacturers add a variety of sugar-containing products to our foods
– often referred to as ‘hidden sugars’. Most of these products are added to
enhance the sweetness of the food, however, these products also can extend
the shelf life of a product, promote browning in foods, help to retain
moisture in bakery items, and improve food consistency.
Nutritive sweeteners refer to sugar-containing products used for their
sweetening capacity. For many years, sucrose was the most commonly
added nutritive sweetener, however, in the mid-1980s corn sweeteners
became the product of choice for many food manufacturers. Corn
sweeteners are produced by the enzymatic breakdown of maize starch. They
are similar in taste to sucrose, but are significantly less expensive to
produce. Corn sweeteners are now the predominant sweeteners in a number
of foods
Examples of nutritive sweeteners
o Cane and beet sugar Corn
o Cane and beet sugar and corn sweeteners are subsets of total nutritive
sweetener consumption.
o High fructose corn syrup (HFCS) is a subset of corn sweeteners.
o Low-calorie sweetener data consist of saccharin and aspartame.
The WHO recommends a diet that contains no more than 10% dietary
sugars for the prevention of obesity, diabetes and dental caries.Nutritive
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sweeteners are found in ice cream, gelatin desserts, cereals and cookies and
other baked goods, we may not be as aware that sweeteners are added to
foods as varied as pizza, hot dogs, lunch meats, soups, spaghetti sauce,
ketchup, salad dressings, boxed rice mixes and canned vegetables.
The past few decades have seen an explosion of sugar-containing foods

including soda, high-fructose corn syrup flavored fruit beverages and low-fat
snacks. Lowfat foods are often a surprising source of sugar for consumers.
Fat carries flavor in foods, and when fat is removed, more of other
ingredients need to be added to boost flavor. Since sugar is a relatively
inexpensive and flavor-enhancing ingredient, these foods have more added
sugar than their higher-fat counterparts.
9.2.1 Metabolism of sugar

All carbohydrates are ultimately broken down into glucose. The body treats
sugars added to foods the same way as it treats the sugars found naturally
occurring in fruits and other foods. Therefore, natural are not any better or
worse for the body than added sugars. Fructose is rapidly metabolized to
glucose in the intestinal mucosa hence the metabolism of sugar basically
refers to sugar metabolism.
After absorption, glucose is carried in the blood stream to the liver, brain
and other tissues. Glucose is removed from the blood stream to the liver,
brain and other tissues. Glucose is removed from the blood stream by
insulin, and stored in the liver as glycogen. The liver can store glycogen,
sufficient for use through ten (10) hours fast; any excess that it cannot
accommodate is converted into fat and stored in adipose tissue in fat cells.
When needed, glycogen is retrieved and broken down into glucose by
glucagon. Glucose is the primary fuel for the brain, though it is not stored in
there. In addition, the brain lacks the enzymes present in the liver for
converting amino-acids and fats into glucose hence it relies on circulating
blood glucose levels for fuel.
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9.2.2 Sugar and cognitive behavior
There is a link supported by research between sugar consumption, blood
glucose levels and cognitive abilities. Because glucose is the primary fuel for
the brain, the availability of glucose to the brain may influence the
performance of mental tasks. Specifically, glucose intake can facilitate
cognitive behavior while impairment in glucose metabolism can negatively
impart cognitive performance.
The positive effects of acute sugar consumption on cognition have been
demonstrated in all age groups, as well as people with Down syndrome and
Alzheimer’s disease. For example, in infants, it is argued that the preference
for sweet foods and for faces develops early in humans to help an infant for
a bond with the mother, thus increasing survival.
Young children perform significantly better on vigilance task shortly after
consuming a sugar containing product.
Adults working memory is significantly improved in college-students given a
glucose drink (if measured by a listening span test). Poor glucose regulation
has been associated with poorer performance in cognitive tests. Typically,
the intake of glucose improves cognitive performance more on difficult than
easy cognitive tests.
In addition, blood glucose falls more sharply following more demanding
tasks than for easier ones. This mental work leads to a depletion of glucose
which is reflected in falling blood glucose levels. Therefore, by consuming a
food or a beverage containing sugar, the resulting elevation in blood glucose
levels enhances cognitive performance.
NB: decrements in cognitive functioning are common in people with diabetes
hence in improvements in glycemic control leads to enhanced cognitive
performance.
9.2.3 Sugar and mood
Culturally, people have a belief that sugar intake enhances mood and
decreases fatigue. The intake of pure carbohydrates can lead to an increase
in the neurotransmitter serotonin which may then improve mood. e.g. some
researchers found that people who reported greater levels of anxiety,
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depression, and fatigue also reported greater cravings for high
carbohydrates/ high fat foods than people who craved protein-rich foods.
Carbohydrates intake increases blood glucose levels which in turn elevates
mood. However, foods consumed to enhance mood are typically highly
palatable and contain not only sugars but also fats.
Therefore, some of the effects of sweet foods on mood may be attributed
either to other components of the food itself or to sensory characteristics
including taste, mouth feel and smell, although such foods would generally
be sweet.
9.2.4 Sugar and hyperactivity
many parents and teachers believe that the intake of sugary foods lead to an
increase in activity in children in general and specifically, an aggravation of
attention deficit hyperactivity disorder (ADHD) symptoms in children with
the syndrome.
There has however been no scientific evidence to support the myth. ADHD
presents with symptoms ranging from inattention to the stereotypical
restlessness. Diagnosed children have difficulty cooping with
overstimulation, changes in daily routine and periods of concentration
focus.
Some researchers have shown that sugar consumption has little or no
effects on behavior. Clinical investigations have demonstrated a significant
effect of sucrose on aggressive or disruptive behavior, motor activity, or
cognitive performance in children.
9.3 Caffeine, methylxanthines and behaviour
While coffee, tea and soft drinks differ widely in taste and nutrient
composition, they share an important characteristic- they all contain
chemicals called methylxanthines. There are several types but only three are
commonly found in foods:
o Caffeine- naturally sound in coffee, kolanuts, tea and chocolate and is an
added ingredient in over 70% of soft drinks
o Theophylline- commonly found in tea
o Theobromine- commonly found in chocolate
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The three of them have significant physiological action. However, it is an
action of these drugs on the central nervous system, which contributes most
significantly to their use. As a group, they are the most commonly
consumed psychoactive substances in the world.
Caffeine
Coffee- the caffeine levels in a cup of coffee vary depending on the way the
beverage has been brewed; the duration of roast- roasting for a short time
leads to more caffeine than darker roast. However, the caffeine content is
inversely related with the strength of flavour.
Tea- by weight, tea leaves contain more caffeine than an equal amount of
coffee beans. However, a smaller quantity of tea leaves is required for a cup
of tea than the quantity of coffee.
Cocoa/ chocolate- a cup of cocoa or glass of chocolate milk contains 5-10
mg of caffeine and 250 mg of theobromine. Caffeine from chocolate makes
up only a small part of total caffeine intakes in adults; but a major source of
methylxanthines for many children.
NB: a growing source of caffeine for children and adolescents is soda, sports
drinks and waters with added amounts of the drug.
Caffeine, theophylline and theobromine are also found in a wide variety of
foods (e.g. yoghurts, ice-creams and energy bars) and pharmaceutical
products such as analgesics, allergy and asthma medications and weight
control products. Generally, caffeine consumption is of great concern to
children, pregnant women and any other individual who may wish to avoid
caffeine.
Caffeine helps in:
 Boosting physical performance especially in athletes both during training
and competition. It is also common in the military where sustained
operations are a necessity.
 It increases heart rate, respiration, blood pressure and blood glucose
levels which together contribute to the positive effects of the day on
physical performance
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 When taken, it also increases the energy derived from fat and decreases
energy from carbohydrates hence allowing the individual to sustain
physical activity for longer periods of time.
 It may also reduce the perception of the pain resulting from rigorous
activity- this is partly because of its ability to stimulate the release of
beta-endorphin (the body’s natural ‘pain killer’)
Caffeine and sleep

Caffeine can delay sleep onset, shorten sleep time, reduce the average depth
of sleep, and worsen the subjective quality of sleep. At high doses, it can
cause insomnia.
However, these negative effects do not apply to all individuals. Those who
regularly consume caffeine have fewer problems with sleep after an evening
cup of coffee or tea than those who abstain from it. Moreover, the effects are
also dose-dependent.
Caffeine and cognitive behavior

In regular caffeine users, cessation of use is associated with mild withdrawal
symptoms such as headache, irritability, mental confusion and fatigue
symptoms would begin 12-24 hours after the last caffeine intake.
Although conflicting data exists, most studies show that moderate levels of
caffeine have beneficial effects on cognitive behavior. Generally, it results in
an increase in alertness and a decrease in fatigue. However, it appears to be
beneficial in facilitating performance of tasks requiring sustained attention
such as vigilance tasks.
There is little evidence that it improves intellectual abilities except when
normal performance has been lowered by fatigue.
Those who develop sleep-deprivation are disadvantaged because they often
suffer from impairment in cognitive functioning including a decreased ability
to concentrate and subsequent decrements in tasks requiring sustained
attention, logical reasoning and perceptual skills such as driving a car. To
reverse these adverse effects one should sleep even if it is a short nap (15-30
min).
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NB: the longer the sleep episode the greater the restoration in cognitive
functioning.
Alternatively, one can take a cup of coffee or tea or a caffeine pill.
Caffeine can also reverse the impairments in cognitive performance
associated with minor illnesses such as colds, flu or fatigue.
9.3.1 Modes of Action of caffeine within the central nervous system
(CNS)
Caffeine exerts its biological action via several different mechanisms which
include:
a. Altered cellular calcium conduction
b. Increased cyclic AMP (adenosine monophosphate)
c. Antagonism of adenosine receptors.
The first two are seen at doses greater than normal. Adenosine is found
throughout the CNS and is considered a neuromodulator which produces its
behavioural effects by inhibiting the conduction of messengers at synapses
that use other neurotransmitters such as dopamine and nopinephrine.
Receptors for adenosine are present in the gastro-intestinal tract, the heart,
blood vessels, respiratory system and brain.
Stimulation of peripheral adenosine receptors decreases intestinal
peristalsis, reduces blood pressure and heart rate and increases bronchial
tone. In the brain, adenosine inhibits neural activity resulting in feelings of
fatigue and behavioural depression.
All these are opposite of many caffeine’s commonly observed reactions hence
the hypothesis that most caffeine’s effect can be attributed to its ability to
act antagonistically to adenosine receptors.
Chronic caffeine use is accompanied by an increase in the number of
adenosine receptors. As a result, a new balance between endogenous
adenosine and the presence of exogenous caffeine occurs leading to a
reduction in some of the physiological and behavioural actions of the drug
(tolerance).
If this balance is altered by severely decreasing or abruptly stopping caffeine
use then the excess adenosine receptors would no longer be blocked by
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caffeine and the physiological response to adenosine would be exaggerated
resulting in symptoms of caffeine withdrawal.
Caffeine intoxication
Intake of caffeine in large quantities (10g) can have negative consequences
such as vomiting and convulsions and in some cases death. In addition,
regular intake of smaller amounts (beginning at approximately 1g/ day), can
lead to nervousness, irritability, loss of appetite, neuromuscular tremors
and vomiting.
Caffeine and Addiction
Caffeine is a drug that produces physiological, psychological and
behavioural effects. There has been a debate of whether caffeine is a drug of
abuse such as heroine, nicotine, alcohol and cocaine.
The drugs of abuse usually produce pleasurable or reinforcing effects.
Caffeine’s reinforcing properties are similar in characteristics (but not in
magnitude) to psycho stimulant drugs such as cocaine or amphetamine.
Caffeine’s reinforcing effects are also relatively weak. Moreover, individuals
do not normally need to consume increasing amounts of caffeine
(characteristic of drug abuse), but rather use it at consistent and moderate
levels (drug use).
Caffeine users develop tolerance to some of the physiological effects of
caffeine such as elevated heart rate and blood pressure, but typically do not
show tolerance to the mood elevating and sleep-delaying effects.
Withdraw from caffeine can be accompanied by headache, fatigue,
depression, difficulty concentrating, irritability and sleepiness. For those
trying to abstain from caffeine, symptoms of withdraw normally are
relatively mild and subside within a few days. However, in some individuals,
withdrawal symptoms can lead to impairment
9.3.2 Physiological Effects of Methylxanthines on Body Systems
Cardiovascular system
The actions of caffeine and other methylxanthines on cardiovascular system
are complex and sometimes antagonistic. This is because the drug’s effects
depend on an individual’s history of consuming methylxanthines, the dose
of the drug and the route of administration.
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Caffeine intake is associated with a rise in blood pressure and increase in
heart rate especially intake >250mg. its effect on blood pressure is more
pronounced among the elderly.
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Smooth muscles
The methylxanthines relax a variety of smooth muscles including those
found in the bronchi of the lungs. Therefore, theophyllines are used in
making the drugs for asthma (prophylactic therapy). They are also used
widely prescribed to prevent episodes of the loss of effective breathing (sleep
apnea) in pre-term infants.
Gastrointestinal system
Caffeine stimulates the secretion of gastric acid and pepsin. Consequently,
coffee intake is often considered detrimental to individuals suffering from
gastric ulcers. However both caffeinated and decaffeinated coffee have
similar effects of gastric secretions, meaning that additional components in
coffee are responsible to its actions on the system.
Renal system
The diuretic action of caffeine and other methylxanthines has long been
recognized. Acute ingestion results in the short-term stimulation of urine
output and sodium excretion in individuals deprived of caffeine for days or
weeks.
Regular intake of caffeine is however associated with the development of
tolerance to the diuretic effects of the drug so that its actions to the renal
system are reduced in such individuals.
Reproductive system
The potentially harmful effects of caffeine intake during pregnancy has long
been known. Intake has been blamed for infertility, miscarriage, low birth
and birth defects. Research has shown that lower doses have negligible
effects on fetal development. Heavy caffeine (> 700mg/day) may be
associated with a decreased probability of pregnancy and an increased
probability of miscarriage or having a preterm delivery. It also increases the
risks of an infant suffering from sleep apnea or sudden infant death
syndrome
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9.4 Food addictives and behaviour
Food additivesare the substances added to the products in order to improve
the properties such as taste, smell, flavour, appearance, nutritional value
and shelf life of foods.
The relation between food additives and behavior is evaluated rather
considering the effects of additives increasing hyperactivity- attention,
Deficit Hyperactivity Deficit Disorder (ADHD). This disorder is the most
common disorders of childhood and affects approximately 3-10% of the
children during the school terms and is more frequent in boys.
Characteristics of ADHD
ADHD often begins to reveal itself with findings such as inattentive,
hyperactivity, impulsivity, intolerance against obstacles, ill humour,
aggression, adjustment difficulties, emotional lability, and impulsive
behavior after 3 years old.
In the first years of school, findings such as incapability of learning,
perceptional problems and school failure are prominent.
Although the causes of the disorder are unknown, genetic and
environmental factors play a role in the formation of the disease.
Some studies have shown that there is a significant decrease in the
hyperactive behaviors with the withdrawal of chemical/ artificial colorants
and preservatives from the diet; and there was a significant increase with
the addition of these substances in the diet, and this changing was
independent of the underlying disease.
The Additive-free Foods
A study conducted among 17 nuns fed with organic foods for a month and
physiological and psychological effects were evaluated. Decrease in blood
pressure, strengthening in the immune system, physical fitness and an
increase in mental clarity were observed. In addition, they were also found
to suffer from fewer headaches and could cope better with stress.
Another study was also conducted to investigate whether nutrition in
childhood is associated with the tendency to violence in adulthood. Those
who ate foods like chocolate, cake, candy, etc every for 10years in their
childhood were assessed when they attained 34 years and it was determined
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that they were sentenced from violence significantly more than those who
had not eaten them. Therefore, food additives in foods consumed might
increase aggression.
Food additives and the impact on mood and behavior

 Aspartame can trigger migraines in adults who suffer from migraine. in
addition, there are many reports of headaches and other neurological
symptoms from people who drink aspartame containing drinks.
 People suffering from depression become more depressed when they take
aspartame containing drinks. It can also inhibit an enzyme called acetyl
choline esterase, which plays a role in memory and learning.
 A study on children without ADHD (or any other diagnosed difficulty)
found that food colours and sodium benzoate have a significant impact
on attention and hyperactivity scores.
 Artificial food colours E102 and E110 have been shown to cause
deterioration in behavior and zinc status in children with ADHD, but not
in children without ADHD.
NB: None of the additives provide any nutritional benefit, and their removal
from the diet is realist and practical.
Examples of food additives

 Artificial yellow colours: E102 tartrazine, E104 Quinone Yellow, E110
Sunset Yellow (sweets, jelly, soft drinks)
 Artificial red colours: E122 Carmoisine or Azorubine, E123 Amarinth,
E124 Ponceau 4R or Cochineal Red A, E127 Erythrosine, E128 Red 2G,
E129 Allura Red AC (soft drinks, sweets, meat products, jelly)
Other artificial colours: E132 Indigo Carmine, E133 Brilliant Blue,
E142 Green S, E151 Brilliant Black, E155 Brown HT. (sweets, cake
mixes, jelly)
 Preservatives: E210-E219 Benzoates (most commonly used: E211-
Sodium benzoates) (soft drinks)
 Artificial sweeteners: E951 Aspartame (sugar free gum, diet yoghurt,
instant drinking chocolate, soft drinks)
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 Flavour enhancers: 621 Monosodium Glutamate (stock cubes, packet
soup, flavoured crisps, some Chinese take-aways, some sausages and
pies)
9.5 Summary
Determine the food addictives in various foods by reading food labels of
different products in food stores
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UNIT 10: ALCOHOL BRAIN FUNCTIONING AND BEHAVIOUR
10.1 Objectives
 To explain the interaction between alcohol and nutrients
 To explain alcohol consumption and its effect on brain functioning and
behaviour
 To describe fetal alcohol syndrome
10.2 Interaction between alcohol and nutrients
Introduction
Many alcoholics are malnourished either because they ingest too little of the
essential nutrients or because alcohol and its metabolism prevent nutrients
from properly absorbing, digesting and using these nutrients.
Consequently, alcoholics tend to experience deficiencies in protein and
vitamins particularly vitamin A, which may contribute to liver disease and
other serious related disorders.
In addition, Alcohol breakdown in the liver both by the enzymes alcohol
dehydrogenase and by an enzyme system called the microsomal ethanol-
oxidising system (MEOS) generates toxic products such as acetaldehyde and
highly reactive and potentially damaging oxygen-containing molecules.
These products can interfere with the normal metabolism of other nutrients
and contribute to liver cell damage.
Nutritional value of alcoholic beverages

Alcoholic beverages primarily consist of water, pure alcohol (ethanol) and
variable amounts of sugars (carbohydrates). Their content of other nutrients
(e.g. proteins, vitamins and minerals) is usually negligible. They are
therefore considered as “empty calories”.
Carbohydrate contents varies greatly among beverage types. For example:
 Whisky, cognac and vodka contain no sugar
 Red and dry white wines contain 2-10g of sugar per litre (g/l)
 Beer and dry sherry contain 30 g/l
 sweetened white and port wines contain 120g/l
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Alcohol content also varies greatly ranging from approximately 40-50g/l in
beer and coolers to approximately 120g/l in wine and prepacked cocktails to
400-500g/l in distilled spirits
Nutritional status of alcoholics

Generally, manyalcoholic do not consume a balanced. Many alcoholics
suffer various degrees of both primary and secondary malnutrition.
Primary malnutrition-occurs when alcohol replaces other nutrients in the
diet.
Secondary malnutrition- occurs when alcoholics consume adequate nutrients
but the alcohol interferes with the absorption of those nutrients from the
intestine hence making them unavailable.
The most severe malnutrition is accompanied by a significant reduction in
muscle mass. it is generally found in those alcoholics who are hospitalized
for medical complications of alcoholism.
Those who drink heavily but do not require hospitalization for alcohol-
related medical problems, in contrast, often are not malnourished or show
less severe malnutrition. In such alcoholics especially when accompanied by
a high-fat diet and lack of physical activity, may actually lead to obesity of
the trunk of the body.
10.2.1 Alcohol effects on digestion and absorption of essential
nutrients
Even if an alcoholic ingests sufficient nutrients, deficiencies may develop if
those nutrients are not adequately absorbed from the GIT into the blood, are
not broken down properly and / or are not used effectively by the body cells.
The two types/ classes of nutrients highly affected are vitamins and protein.
Amino-acid and protein
Alcohol can interfere with the uptake of essential amino-acids. Patients with
chronic liver failure (many cases are alcoholics) also exhibit a number of
defects in protein metabolism with consequences. These include:
 Decreased production of protein in the liver: (e.g. Albumin and blood-
clotting factors). Decreased production of albumin may lead to
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abnormally low levels of it in the blood. Albumin helps maintain normal
blood levels and also the blood’s concentration of minerals and other
dissolved molecules.Excessively low albumin levels may cause or
exacerbate the abnormal accumulation of fluid in the abdomen (ascites)
of patients with cirrhosis, which may worsen the impaired blood slow
through the patient’s already damaged liver.
 Reduced levels of blood-clotting factors- may predispose patients to the
risk of internal bleeding in the GIT which can have serious health
consequences
 Decreased urea synthesis: urea synthesis serves to remove from the body
(by excreting it in the urine) the toxic ammonia that is generated during
various metabolic reactions (including the breakdown of protein).
Decreased urea production (results in excessive ammonia levels in the
body) may increase the likelihood that patients develop altered brain
function (hepatic encephalopathy).
 Decreased metabolism of a group of amino-acids called aromatic amino-
acids: abnormalities of the normal balance of various types of amino-
acids such as increased levels of aromatic amino-acids, also can increase
the risk of hepatic encephalopathy.
Vitamins
The vitamins that are particularly affected by alcohol consumption include:
thiamin (B1), Riboflavin (B2), pyridoxine (B6), folic acid (B9) and ascorbic
acid (C). The fat-soluble vitamins are also affected but not as much as the
water-soluble vitamins.
the severity of these deficiencies correlates with the amount of alcohol
consumed and with the corresponding decrease in vitamin intake.
Deficiencies are especially common in patients with cirrhosis and from
reduced intake with the diet and for some vitamins, from reduced
absorption such as vitamin A.
Fat-soluble Vitamins and Alcohol
Alcohol inhibits the absorption of fats, which in turn inhibits the absorption
of fat-soluble vitamins.
Alcohol’s effect on vitamin A levels
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 Liver disease alters the liver’s ability to take up beta carotene and / or
convert it into vitamin A. Therefore patients with liver disease especially
cirrhosis would have decreased levels of beta-carotene in the blood. This
occurs because of the impaired conversion of ingested beta-carotene to
vitamin A in the liver due to the alcohol consumption especially at
advanced stages of alcoholic liver disease.
 Alcohol also promotes the secretion of vitamin A from the liver, thereby
enhancing its decline in the liver.
 It also increases the vitamin A content of some tissues and decreases
vitamin A in other tissues.
 It can speed up or alter the conversion of vitamin A to other compounds
which may contribute to alcohol’s toxic effects on the liver and to the
development of liver fibrosis.
NB: on the other hand, excess vitamin A levels can promote the formation of
scar tissue (fibrosis) which is worsened by concurrent alcohol use.
Vitamin B1 (Thiamin)
Alcohol reduces thiamine levels in chronic alcohol users. This is brought
about by an unbalanced diet and alcohol’s impact on absorption, storage,
activation and excretion of thiamin
Deficiency leads to beriberi which can be in two forms: wet and dry beriberi.
Both affect the CNS. A severe deficiency leads to a life-threatening brain
disorder called Wernickle Korsakoff Syndrome characterized by confusion,
paralysis of eye nerves, impaired muscle coordination and persistent
problems with memory and learning abilities. If severe, it can even lead to
permanent brain damage.
Folate
Alcohol interferes with dietary folate intake, absorption, transport, storage
and release of folate by the liver. Alcohol inhibits absorption of nutrients by
killing the cells lining the stomach and intestines that mediate the
absorption of nutrients.
Vitamin B12
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Both moderate and heavy alcohol consumption affects cobalamin levels. It
reduces its absorption. Excess alcohol use can result in a deficiency in this
vitamin that can lead to a nerve disease called peripheral neuropathy
characterised by tingling sensation and/ or pain in the extremities.
Minerals and Alcohol
Calcium: deficiency results from inefficient absorption due to alcohol. It is
also associated with the decreased absorption of fats. Deficiency leads to
softening of fats.
Iron- Alcohol causes deficiency of iron due to gastro-intestinal bleeding.
Deficiency leads to anemia.
Zinc- alcohol decreases absorption. It inhibits the absorption of other
nutrients that zinc depends on for its functions.
Magnesium- Excessive alcohol intake can deplete the body off magnesium
from the body’s tissue including the brain tissue. Chronic deficiency can
lead to high blood pressure, muscle cramps, headaches, diabetes,
osteoporosis and anxiety.
Effects of Alcohol on Blood sugar

 Alcohol interferes with all the three sources of glucose and the hormones
needed to maintain healthy blood sugar levels. Heavy drinkers deplete
their glycogen stores within a few hours when their diet does not provide
a sufficient amount of carbohydrates. Over time, excessive alcohol
consumption can decrease insulin’s effectiveness, resulting in
hyperglycemia.
 Acute consumption increases insulin secretion causing low blood sugar
(hypoglycemia). it can negatively impact blood sugar levels each time that
it is consumed, regardless of the frequency of consumption
 It can also impair the hormonal response that would normally rectify the
low blood sugar.
 It affects the effectiveness of hypoglycemic medications.
NB: a certain study showed that 45-70% of those with alcohol liver disease
had either glucose intolerance or diabetes.
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Metabolism of Alcohol
Once alcohol enters in the stomach, up to 20% of it can be absorbed and get
directly into the bloodstream. Within minutes, it will reach the brain and
give a feeling of being a stimulant. The remaining goes to the intestine for
absorption with other nutrients.
A small amount is excreted through sweat, saliva, urine and breath.
Metabolism occurs in the liver hence liver problems may occur following
excessive alcohol consumption.
Negative effects of too much alcohol include:
 reduced inhibitions
 slurred speech
 motor impairment
 death
 confusion
 memory problems
 concentration problems
Long-term alcohol consumption can cause problems related to the brain,
liver (cirrhosis, steatosis, alcoholic hepatitis, fibrosis) heart (high blood
pressure, cardiomyopathy, arrhythmiasis, stroke), pancrease (pancreatitis),
and immune system.
It can also put one at a risk of certain cancer, including those of the mouth,
esophagus, throat, breast and liver. It can also cause fetal alcohol
syndrome- currently there is no known safe level for alcohol consumption in
pregnancy and lactation.
10.3 Alcohol consumption, brain functioning and behaviour
Alcohol and the Brain
Alcohol is a central nervous system depressant. It acts on the receptor sites
for the neurotransmitters (chemical messengers) known GABA, glutamate
and dopamine. Its activity on the GABA and glutamate sites results in the
physiological effects associated with drinking such as slowing down of
movement and speech.
Alcohol’s activity on the dopamine site in the brain’s reward center produces
the pleasurable feelings that motivate many people to drink
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The degree to which alcohol impacts a person’s mood, behavior and
neurological functioning depends in part on whether the Blood Alcohol
Content (BAC) is elevated or decreasing.
NB: At the beginning, alcohol acts as a stimulant, but as consumptions
tapers off, it acts as a sedative.
The following factors directly influence how alcohol affects a person’s brain
function besides BAC:
 The volume of alcohol consumed
 How often a person drinks
 The age at which drinking began
 The number of years a person has been drinking
 The person’s sex, age and genetic factors
 Whether the person’s family has a history of alcoholism
 Whether the person was exposed to alcohol as a fetus
 The person’s general health condition
Heavy and chronic drinkers
A person who drinks heavily over an extended period of time may develop
deficits in brain functioning that continue even if sobriety is attained. The
cognitive problems do not arise from drinking alcohol but from brain
damage that prior drinking caused.
Most heavy long-term alcohol users will experience a mild to moderate
impairment of intellectual functioning and diminished brain size. The most
common impairments relate to the ability to think abstractly and the ability
to perceive and remember the location of objects in two- and three-
dimensional space (visuo-spatial abilities).
In addition, there are numerous brain disorders associated with chronic
alcohol use such as thiamin deficiency which results to Wernickle Korsakoff
Syndrome (WKS). WKS is a disease that consists of two separate syndromes:
- A short-lived and severe condition called Wernickle’s encephalopathy
characterized with mental confusion, paralysis of nerves that move the
eyes (oculomotor disturbances), and difficulty with muscle coordination
- A long-lasting and debilitating condition known as Korsakoff’s psychosis
charcterised by persistent learning and memory problems. Patients will
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be forgetful and quickly frustrated and have difficulty in walking and
coordination. They will also have problems in remembering old
information (retrograde amnesia) and also “laying down” new information
(anterograde amnesia).
NB: Cognitive impairment can be reversed through abstinence from alcohol
Occasional drinkers: in this case alcohol can produce one or more short-
term effects after one or more drinks. Namely memory impairment can begin
after a few drinks and can increase as the consumption increases or a high
volume of alcohol consumption especially on an empty stomach can result
in a blackout
Moderate drinkers: it refers to a person who consumes one drink (applies
to women) or two drinks (men) per day. It has negative associations such as
increasing the risk of breast cancer and causing violence, falls, drowning
and car accidents. It is associated with cognitive impairments.
10.3.1 Alcohol, gender and cognitive behavior
Blackoutsrefer to an interval of time for which the intoxicated person cannot
recall key details or events, or even entire events.
Women are at greater risks than males for experiencing blackouts. The
difference is due to the way in which men and women metabolise alcohol.
Women are prone also to milder forms of alcohol-induced memory
impairments than men.
Women are also more vulnerable to developing medical consequences than
men e.g. liver cirrhosis, alcohol-induced damage of the heart muscles
(cardiomyopathy) and nerve damage (Peripheral neuropathy) after a few
years of heavy drinking than do alcoholic men.
Both males and females have similar learning and memory problems from
heavy drinking. Both actually show significantly great brain shrinkage, a
common indicator of brain damage. Women’s brains are more vulnerable to
alcohol-induced damage than men.
10.4 Alcohol consumption and pregnancy, fetal alcohol syndrome
Introduction
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Women who drink alcohol during pregnancy can give birth to babies with
Fetal Alcohol Spectrum Disorders (FASDs).The disorders can be mild or
severe and can cause physical and mental birth defects. They include:
 Fetal alcohol syndrome (FAS)
 Partial fetal alcohol syndrome
 Alcohol-related birth defects
 Alcohol-related neurodevelopment disorders
 Neurobehavioural disorder associated with prenatal alcohol exposure
FAS is a severe form of the condition. It is generally characterised by
problems with vision, hearing, memory, attention span, abilities to learn and
communicate.
While the defects vary from one person to another, the damage is often
permanent
Causes of FAS
When a pregnant women drinks alcohol, some of that alcohol easily passes
across the placenta to the fetus. The body of a developing fetus doesn’t
process alcohol the same way as an adult does. The alcohol is more
concentrated in the fetus, and it can prevent enough nutrition and oxygen
from getting to the fetus’ vital organ.
Damage is most likely to occur in the first few before the mother can realize
that she is pregnancy. The risk increases if the mother is a heavy drinker.
Although alcohol appears to be most harmful during the first trimester,
consumption any time during pregnancy can be harmful.
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Symptoms of FAS
Severity of symptoms ranges from mild to severe and can include:
 A small head
 A smooth ridge between the upper lip and nose, small and wide-set eyes,
a very thin upper lip, or other abnormal facial features.
 Below average height and weight
 Hyperactivity
 Lack of focus
 Poor coordination (ataxia) occurs when there is a disruption in
communication between the brain and the rest of the body. This causes
jerky and unsteady movements. Commonly characterized by loss of
balance and coordination.
 Delayed development and problems in thinking, speech, movement, and
social skills.
 Poor judgment
 Problem seeing or hearing
 Learning disabilities and low IQ
 Intellectual disabilities
 Heart problems
 Problems with sleep and suckling as an infant
 Deformed limbs or fingers
 kidney defects abnormalities
 Mood swings
Treatment of FAS
There is no cure for FAS or FASDs. Children can however benefit from
services and therapies such as:
 Speech therapy- language, occupational and physical therapy
 Early intervention education
 Adult classes that help parents and other caregivers handle problem
behavior or other issues
 Classes that teach kids social skills
 Counseling with a mental health professional
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10.1 Summary
Alcohol represents a paradox in today’s society. On the one hand, there is
evidence that moderate alcohol intake can reduce the risk of heart disease
and stroke. On the other hand, excessive alcohol intake is associated with a
myriad of detrimental physiological and behavioural outcomes.
Read about the consequences of the deficiency of fat-soluble vitamins
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UNIT 11: EATING DISORDER SYNDROMES
11.1 Objectives
 To introduce eating disorders
 To describe anorexia nervosa
 To describe bulimia
 To describe binge eating disorders
11.2 Introduction
Eating Disorders describe illnesses that are characterized by irregular eating
habits and severe distress or concern about body weight or shape.
Eating disturbances may include inadequate or excessive food intake which
can ultimately damage an individual’s well-being. The most common forms
of eating disorders include Anorexia Nervosa, Bulimia Nervosa, and Binge
Eating Disorder and affect both females and males.
Eating disorders can develop during any stage in life but typically appear
during the teen years or young adulthood. Classified as a medical illness,
appropriate treatment can be highly effectual for many of the specific types
of eating disorders.
Although these conditions are treatable, the symptoms and consequences
can be detrimental and deadly if not addressed. Eating disorders commonly
coexist with other conditions, such as anxiety disorders, substance abuse,
or depression.
tics frequently come from backgrounds that are characterized by puritanical
attitudes, particularly toward female sexuality. Self esteem can also be a
factor in individuals who become anorexic.
11.2.1 Risk factors for eating disorders
 Individual risk factors:
o Biology- early maturation, overweight
o Personality- Low self-esteem, impulsiveness, inadequate coping skills,
body dissatisfaction, perfectionism.
o Behavior- Dietary restraint, initiation of dating, weight concerns.
 Family risk factors:
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o Parental- Obesity, overprotection, loss or absence, psychopathology,
neglect, physical or sexual abuse.
o Familial- Conflict, concerns about shape or weight, immediate relative
with eating disorder.
 Sociocultural risk factors:
o Peer - Weight concerns among peers, teasing by peers, thin ideal for by
in-group or sorority, thin ideal for sport or team membership.
o Societal - Thin beauty ideal by dominant culture, emphasis on physical
appearance for success, gender role conflict and media influences.
11.3 Anorexia nervosa
Anorexia nervosa is truly an unusual disorder. Although individuals who
suffer from it may show many of the same symptoms that are seen in other
forms of starvation, they have one unique characteristic – that their hunger
is deliberate and self-imposed often seen in young females.
Individuals with this disorder do not suffer from a loss of appetite rather
they suffer from an intense fear of gaining weight. Anorexics are obsessed
with food and food consumption, calculating just how many calories they
can and do consume. But their idea of an acceptable amount of calories is
ridiculously small. In any case, the result of such a reduced level of food
intake is a significant loss of weight, that is, 15% or more.
Anorexia nervosa occurs most frequently in females, with some 85–95% of
the reported cases occurring in adolescent girls. The remaining cases are in
prepubertal boys and older women. The mean age of onset is 17 years of
age, with peaks at 14 and 18 years, ages that would seem to correspond to
the girls’ transitions to high school and college, respectively.
More recent research has not shown any associations between the social
classes of anorexic patients versus members of the general community
though it may be that the disorder has become more diffused through the
population through greater access to education and upward mobility. There
are no clearly established associations between particular religious
backgrounds and the development of eating disorders, although some have
speculated that anorectics frequently come from backgrounds that are
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characterized by puritanical attitudes, particularly toward female sexuality.
Self esteem can also be a factor in individuals who become anorexic.
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11.3.1 Diagnostic criteria for anorexia nervosa
 Refusal to maintain body weight at or above a minimally normal weight
for age and height. A weight of 85% or less than what an individual’s
minimal body weight should be, given their frame and height. For
example, a 20-year-old woman of medium build who is 5 feet 4 in tall
(1.63 meters) would satisfy this criterion if she dropped to a weight of 105
lb (48 kg) or less.
 Intense fear of gaining weight, even though underweight.
 Disturbance in the way in which one’s body weight or shape is
experienced, undue influence of body weight or shape on selfevaluation,
or denial of the seriousness of the current low body weight. Body image
distortion in terms of self perception (the individual cannot see that
she/he is underweight but perceives themselves as still being overweight)
and body image (perception of physical appearance).
 In postmenarcheal females, the absence of at least three consecutive
menstrual cycles. In the restricting type, the individual restricts food
without regularly bingeing or purging. In the bingeing/purging type, the
individual severely restricts food and binges or purges.
Along with loss of weight, fear of fatness and a disturbed body image, a
female must stop menstruating in order to be classified as anorexic, or must
have her menarche delayed if she is prepubertal. This physiological
disturbance has been attributed to primary nervous system dysfunction, but
may be better explained by caloric restriction and the lowered fat content of
the body. Presumably this serves to protect the female from becoming
pregnant, which would place even greater demands on her body.
The restricting type relies on her ability to sustain self-control in not eating.
In addition, this type of anorexic will engage in frequent, regular and
vigorous exercise as an added means of displacing hunger as well as to work
off calories from the minimal amounts of food that she has eaten
11.3.2 Physiological consequences
It affects all major organ systems of the human body, most notably the
cardiovascular, dermatological, gastrointestinal, skeletal, endocrine and
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metabolic systems. Many of the medical complications are similar to those
that accompany other forms of starvation with the severity of the
physiological changes that occur in anorexia nervosa varies directly as a
function of the degree of reduced food intake and body weight.
o Gastrointestinal: Delayed gastric emptying, bloating, constipation,
abdominal pain.
o Haematological: Iron deficiency anemia, decrease of white blood cells.
o Cardiac: Loss of heart muscle, cardiac arrhythmia, increased risk of
sudden death.
o Osteopathic: Decalcification of bone, premature osteoporosis.
o Neuropsychiatric: Abnormal taste sensations, depression, mild cognitive
disorder.
o Other: Growth of fine hair on trunk, loss of fat stores and muscle mass.
Reduced thyroid metabolism and difficulty in maintaining body
temperature.
The severe medical complications of anorexia nervosa involve the
cardiovascular system. Cardiovascular changes that result from anorexia
include low heart rate, low blood pressure, tachycardia, ventricular
arrhythmia, congestive heart failure and sudden death due to cardiac
failure.
The metabolic changes associated with anorexia nervosa are similar to those
seen with starvation. After a number of days of semi-starvation, glycogen
reserves are first depleted, then protein oxidation increases until ketogenesis
kicks in, at which point fat oxidation occurs. This can result in elevated free
fatty acids and higher plasma cholesterol. If the individual continues to eat
fewer calories than are required for the body’s needs, tissue may eventually
be consumed in order to supply the energy deficit. Anorexia nervosa can
result in electrolyte imbalances, anemia and other mineral deficiencies,
kidney stones if chronically dehydrated and edema during the refeeding
process.
Clinical features of anorexia nervosa
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 Dermatological signs of anorexia include brittle nails, dry, thin and scaly
skin, often orange in colour due to carotene.
 While hair loss may occur, undernutrition may result in fine, silky hair
(lanugo) on the back, face and extremities
 Anorexic women are by definition amenorrheic, which is common in
other starvation states and may be attributable to caloric restriction. One
in six anorexic patients develops amenorrhea before weight is lost and
the absence of menses may continue even after their weight is restored.
Additional signs and symptoms of anorexia
 Chronic restrictive eating or dieting, beyond the norm
 Rapidly losing weight or being significantly underweight and emaciated
 Obsession calories and with fat contents of food
 Engaging in ritualistic eating patterns, such as cutting food into tiny
pieces, eating alone, and/or hiding food
 Continued fixation with food, recipes, or cooking; the individual may cook
intricate meals for others but refrain from partaking
 Depression or lethargic stage
 Avoidance of social functions, family, and friends. May become isolated
and withdrawn
Psychological characteristics of anorexia nervosa

 Irritability, low tolerance for stress and sexual disinterest, but also a
preoccupation with food and bizarre eating habits characterize both
anorexia nervosa and starvation.
 The anorexic also avoids emotional intimacy and social interaction, yet
maintains a dependency on others.
 In anorexia, a preoccupation with food may manifest itself by preparing
meals for others, collecting recipes, attending cookery classes, or taking
courses in nutrition and dietetics. Bizarre eating habits may include
refusing to eat in the presence of others or taking an extremely long
period of time to eat a small amount of food.
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 They also display a severe distortion in their body image; misperceive
their body size as larger than they actually are regardless of what the
scale indicates or the assurances of their trusted friends.
Distinguishing between starvation and anorexia
Anorexics frequently misinterpret both internal and external stimuli. For
example, internal cues for hunger are redefined as positively reinforcing,
with less and less food necessary to feel full, perhaps an outgrowth of the
delay in gastric emptying.
Anorexics also demonstrate lessened responsiveness to external stimuli
such as cold and sexual stimulation. Unlike starving individuals who
become easily fatigued and avoid physical activity, anorexics are often
hyperactive and deny feeling fatigued because exercise may be used to
further assist in weight loss.
Anorexics feel helpless in regard to most matters, but they can control their
eating, so their self-discipline with respect to not eating is extraordinary.
Fear of gaining weight and becoming fat serves as motivation for an anorexic
11.3.3 Anorexia Treatment
Seeking anorexia recovery from a well-qualified team of eating disorder
specialists, consisting of a therapist, physician and nutritionist are
recommended. Effective, holistic eating disorder treatment of anorexia
involves three necessary components:
Medical: The highest priority in the treatment of anorexia nervosa is
addressing any serious health issues that may have resulted from the eating
disordered behaviours, such as malnutrition, electrolyte imbalance,
amenorrhea and an unstable heartbeat.
Nutritional: This component encompasses weight restoration,
implementation and supervision of a tailored meal plan, and education
about normal eating patterns.
Therapy: The goal of this part of treatment is to recognize underlying issues
associated with the eating disorder, address and heal from traumatic life
events, learn healthier coping skills and further develop the capacity to
express and deal with emotions.
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11.4 Bulimia
Bulimia nervosa is defined by a binge– purge cycle of food intake. Bulimia
nervosa is more prevalent than anorexia nervosa but it is more difficult to
establish because the condition is not as physically obvious. More men
suffer from bulimia nervosa than anorexia nervosa, but as with anorexia the
disorder occurs primarily in women. While many women with bulimia may
also have anorexia, the average bulimic tends to be heavier and older than
the typical anorexic patient.
Excessive amounts of calories are indeed ingested, but the individual
compensates for the binge by purging through self-induced vomiting or
other techniques. The primary distinction between the diagnoses of bulimia
and anorexia may in fact be in the eating patterns, as bulimia is
characterized by such frequent binges on food, while anorexia includes
persistent efforts to restrict food. Most bulimic individuals will rarely eat a
normal meal; in social setting food consumed is minimal but they will binge
in private especially during the evening.
Foods consumed during a binge tend to be high in fat and carbohydrates, as
food is eaten for emotional comfort and not nutritional value. Binge eating
may be brought on by depression, stress, frustration, boredom or just the
sight of food. Disinhibition that restrained eaters experience when stressed
or depressed may characterize the bulimics who make repeated attempts at
dieting to lose weight. Following a binge, the individual typically feels further
anxiety, depression and then guilt. Due to humiliation because of having
lost control or recognizing that all those calories will take their toll, the
bulimic then seeks to undo overeating. Most will regurgitate the food they
eat, and many bulimics will anticipate vomiting in advance of their
overeating. For other bulimics, purging is accomplished by using laxatives
or diuretics. Unlike the anorexic, the individual with bulimia nervosa is
aware of the abnormal behavior and thus attempts to hide it from family
and friends.
11.4.1 Major Types of Bulimia
There are two common types of bulimia nervosa, which are as follows:
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a. Purging type – This type of bulimia nervosa accounts for the majority of
cases of those suffering from this eating disorder. In this form,
individuals will regularly engage in self-induced vomiting or abuse of
laxatives, diuretics, or enemas after a period of bingeing.
b. Non-purging type – In this form of bulimia nervosa, the individual will
use other inappropriate methods of compensation for binge episodes,
such as excessive exercising or fasting. In these cases, the typical forms
of purging, such as self-induced vomiting, are not regularly utilized
11.4.2 Diagnostic criteria for bulimia
1. Recurrent episodes of binge eating, characterized by one or both of the
following:
- Eating, in a discrete period of time, an amount of food that is
definitely larger than most people would eat during a similar period of
time and under similar circumstances
- A sense of lack of control over eating during the episode.
2. Recurrent inappropriate compensatory behavior in order to prevent
weight gain, such as self-induced vomiting; misuse of laxatives, diuretics,
enemas or other medications; fasting; or excessive exercise.
3. The binge eating and inappropriate compensatory behaviours both occur
on average at least twice a week for 3 months.
4. Body shape and weight unduly influence the person’s self-evaluation.
In the purging type, the individual uses regular purging behavior. In the
non-purging type, the individual uses other inappropriate compensatory
behaviours, such as fasting or excessive exercise, but does not regularly
engage in purging.
11.4.3 Consequences of purging in bulimia nervosa
The bulimic patient may superficially appear to be the picture of health,
being of normal weight and shape but physical complications of bulimia can
affect almost every system of the body. They can range from minor
problems, such as abrasions on the knuckles from continual use of the
hand to induce vomiting, to life threatening difficulties such as electrolyte
disturbances resulting from continual purging.
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Many of the medical complications of bulimia nervosa are side effects of
disordered eating practices. The rapid consumption of large amounts of food
can lead to acute gastric dilation with resulting discomfort. Inflammation of
the pancreas, abdominal distention and pain and increased heart rate may
develop as a consequence of abrupt pancreatic stimulation during frequent
binge eating episodes.
Most bulimic patients vomit regularly after a binge episode in order to
remove what they have eaten. However, recurrent vomiting of the stomach’s
acidic contents can result in erosion of the esophagus, which if torn, can be
a life threatening event in itself. Dental erosion, gum problems and swelling
of the salivary glands are also common consequences of continual vomiting,
and can serve as a diagnostic indicator of bulimic behavior.
Repeated vomiting can also lead to fluid loss, dehydration and electrolyte
imbalances. Bulimic patients may experience excessive thirst with decreased
urinary output, resulting in edema from excess water being retained. The
loss of sodium, potassium and chloride from the body can lead to a variety
of cardiac symptoms ranging from irregular heartbeat to congestive heart
failure and cardiac death.
Laxative and diuretic abuse is also a common compensatory behavior. The
use of laxatives or diuretics can become addictive, with bulimic patients
developing tolerance for their effects and thus resorting to using increasing
amounts. Chronic use of laxatives or enemas can result in the loss of
normal colon functioning, which may become so severe that colonic
resection is necessary. In addition, laxative and diuretic abuse can lead to
shifts in fluid balance, electrolyte imbalances, dehydration, malabsorption,
abdominal cramping and muscle cramps.
11.4.4 Psychological characteristics of bulimic individuals
 They have a distorted view of their own weight and shape, and desire to
weigh much less than they do.
 Obsession with controlling their food intake though for bulimic this
proves to be unsuccessful as they binge eat and then purge.
 Bulimics are more likely to display symptoms of depression and show
greater changes in mood.
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 Bulimics tend to engage in more sexual behavior.
11.4.5 Bulimia Treatment
Since negative body image and poor self-esteem are often the underlying
factors at the root of bulimia, it is important that therapy is integrated into
the recovery process. Treatment for bulimia nervosa usually includes:
 Discontinuing the binge-purge cycle: The initial phase of treatment for
bulimia nervosa involves breaking this harmful cycle and restoring
normal eating behaviours.
 Improving negative thoughts: The next phase of bulimia treatment
concentrates on recognizing and changing irrational beliefs about weight,
body shape, and dieting.
 Resolving emotional issues: The final phase of bulimia treatment focuses
on healing from emotional issues that may have caused the eating
disorder. Treatment may address interpersonal relationships and can
include cognitive behavior therapy, dialectic behavior therapy, and other
related therapies.
11.5 Binge eating disorder
Binge Eating Disorder (BED) is commonly known by compulsive overeating
or consuming abnormal amounts of food while feeling unable to stop and at
loss of control. Binge eating episodes are typically classified as occurring on
average a minimum of twice per week for a duration of six months.
Individuals who suffer from Binge Eating Disorder will frequently lose
control over his or her eating. Different from bulimia nervosa however,
episodes of binge-eating are not followed by compensatory behaviors, such
as purging, fasting, or excessive exercise. Because of this, many people
suffering from BED may be obese and at an increased risk of developing
other conditions, such as cardiovascular disease. Men and women who
struggle with this disorder may also experience intense feelings of guilt,
distress, and embarrassment related to their binge-eating, which could
influence the further progression of the eating disorder.
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11.5.1 Causes of binge eating disorder
While the exact cause of binge eating disorder is unknown, there are a
variety of factors that are thought to influence the development of this
disorder. These factors are:
o Biological: Biological abnormalities, such as hormonal irregularities or
genetic mutations, may be associated with compulsive eating and food
addiction.
o Psychological: A strong correlation has been established between
depression and binge eating. Body dissatisfaction, low self-esteem, and
difficulty coping with feelings can also contribute to binge eating disorder.
o Social and Cultural: Traumatic situations, such as a history of sexual
abuse, can increase the risk of binge eating. Social pressures to be thin,
which are typically influenced through media, can trigger emotional eating.
Persons subject to critical comments about their bodies or weight may be
especially vulnerable to binge eating disorder.
11.5.2 Signs and symptoms of binge eating disorder
As individuals suffering from binge eating disorder experience
embarrassment or shame about their eating habits, symptoms may often be
hidden.
The following are some behavioural and emotional signs and symptoms of
binge eating disorder:
 Continually eating even when full
 Inability to stop eating or control what is eaten
 Stockpiling food to consume secretly at a later time
 Eating normally in the presence of others but gorging when isolated
 Experiencing feelings of stress or anxiety that can only be relieved by
eating
 Feelings of numbness or lack of sensation while bingeing
 Never experiencing satiation: the state of being satisfied, no matter the
amount of food consumed
The consequences of binge eating disorder involve many physical, social,
and emotional difficulties.
Some of these complications are:
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 Cardiovascular disease
 Type 2 Diabetes
 Insomnia or sleep apnea
 Hypertension
 Gallbladder disease
 Muscle and/or joint pain
 Gastrointestinal difficulties
 Depression and/or anxiety
11.5.3 Binge Eating Disorder Treatment
Professional support and treatment from health professionals specializing in
the treatment of binge eating disorders, including psychiatrists,
nutritionists, and therapists, can be the most effective way to address binge
eating disorder.Such a treatment program would address the underlying
issues associated with destructive eating habits, focusing on the central
cause of the problem.
It is necessary to concentrate on healing from the emotional triggers that
may be causing binge eating, having proper guidance in establishing
healthier coping mechanisms to deal with stress, depression, anxiety, etc.
There are also three types of therapy that can be especially helpful in the
treatment of binge eating disorder. These therapies are:
 Cognitive-behavioural therapy (CBT): A type of therapy aimed at helping
individuals understand the thoughts and feelings that influence their
behaviors.
 Interpersonal psychotherapy (IPT): A form of therapy in which the focus
is on an individual’s relationships with family members and peers and
the way they see themselves
 Dialectical Behavior Therapy (DBT): A type of therapy that focuses on
teaching individuals skills to cope with stress and regulate emotions
In addition to these methods, group therapy sessions led by a trained eating
disorder therapist, as well as eating disorder support groups, may also be
effective methods of establishing recovery from binge-eating disorder.
Eating Disorders are complex disorders, influenced by a facet of factors.
Though the exact cause of eating disorders is unknown, it is generally
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believed that a combination of biological, psychological, and/or
environmental abnormalities contribute to the development of these
illnesses.
Describe nutritional, psychological and pharmacological treatment of eating
disorders
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UNIT 12: BEHAVIOURAL ASPECTS OF OVERWEIGHT AND OBESITY
12.1 Objectives
 To introduce behavioural aspects
 To explain social cultural correlations
 To outline physiological consequences
 To determine biological and behavioural influences
 To identify restrictive feeding practices
 To outline treatment and preventive approaches
12.2 Introduction
Over nutrition is an ever increasing phenomenon of significant concern
resulting from a myriad of causes such as overeating as it leads to health
problems and psychological distress. Excessive body weight has been
demonstrated to increase the risk of various diseases and disabilities and is
associated with a number of adverse social and psychological consequences.
Obesity is a clinical condition characterized by the excessive accumulation
of body fat. The Quetelet Index (1981), or Body Mass Index (BMI) provides
the most clinically relevant assessment of obesity across varied populations.
BMI describes relative weight for height and is calculated by dividing the
individual’s body weight by the square of his or her height. BMI estimates
between 18.5 and 24.9kg/m2in adults reflect normal or healthy weight.
Overweight status is determined by a BMI of 25 or higher, with obesity
reserved for a BMI of 30 or higher. The association between BMI and body
fat content will vary across age, sex and ethnic groups because of lean
tissue mass and hydration status.
Shortcomings of BMI
BMI is significantly correlated with total body fat content, is a more precise
measure of total body fat than weight alone. Despite the widespread
acceptance of BMI as the most practical measure of overweight and obesity
in adults, it must be remembered that weight and height are only a proxy for
body composition. For example, a bodybuilder may be classified as
overweight by BMI standards, but would not likely be overfat. In addition,
BMI is less accurate with individuals who are extremely short or tall, and
cannot gauge whether someone who is of normal weight but is extremely
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sedentary might have excess body fat. With children, growth charts must be
used that plot BMI by sex and age. For these reasons clinical assessments
are necessary for interpreting BMI in situations where body weight may be
affected by increased muscularity or even disease. Nevertheless, for most
individuals BMI provides a very good approximation of total body fat.
12.3 Etiology of obesity
The reason for gaining of excess weight is that over an extended period of
time an individual’s energy intake is greater than his or her energy
expenditure. A positive energy balance occurs when energy intake exceeds
energy expenditure and weight gain is promoted. Conversely, a negative
energy balance results in a decrease in fat stores with subsequent weight
loss. Body weight is regulated by a series of physiological processes that
have the capacity to maintain a stable weight within a narrow range, or set
point.
12.4 Social cultural correlates
Many socio-cultural variables are associated with the tendency for increased
body fat. The socio-cultural factors may be broken down into:
i. Social characteristics
- Fatness increases over the course of adulthood
- Fatness declines in the elderly
- Obesity rates are higher for women than men.
ii. Social contexts
- Obesity rates are higher in developed countries than developing
countries
- Obesity rates are higher for rural women than urban women
- Obesity rates are higher for married men than single men.
- Older people living with others have a higher rate of obesity than
those who live alone.
iii. Socio-economic status
- Obesity rates are higher in people with less prestigious jobs
- Obesity rates are higher in low-income women
- Obesity rates are higher in less educated women
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- Obesity rates are higher in women who are not employed outside the
home.
12.5 Physiological consequences
Heart disease is associated with a BMI ≥ 30, as are hypertension, stroke,
diabetes, gallbladder, joint diseases and some forms of cancer. For men,
obesity in early adulthood has been linked to cardiovascular disease, while
for women weight gain during mid-adulthood has shown a stronger
association. Hypertension is higher in the overweight than in those who are
not overweight. In combination with high blood cholesterol and high serum
triglycerides, which are also linked to being overweight, hypertension
contributes to atherosclerosis and coronary heart disease. Adult onset
diabetes (Type 2) appears to have the strongest association with obesity.
Obesity compromises glucose tolerance, increases insulin resistance and
diabetes in turn may cause heart disease, kidney disease and vascular
problems.
The location of fat is a risk factor for disease;
 ‘Apple’ shape or android where fat is collected in the belly. the ‘apple’ shape
is associated with greater health risks than the ‘pear’ shape pattern more
often seen in women since excess fat in the abdominal region appears to
raise blood lipid levels, which then interfere with insulin function.
Visceral fat (that fat which surrounds the organs of the abdominal cavity) is
linked to hyperlidemia, hypertension, heart disease and diabetes. Several
types of cancer are associated with being overweight and possessing excess
abdominal fat. Overweight men are at heightened risk for developing cancer
of the prostate, colon and rectum. Overweight women are at greater risk for
developing cancer of the colon, gallbladder, uterus, cervix, ovary and
breast.
 ‘Pear’ shape or gynoid where fat collects in the hips and buttocks.
12.5.1 Consequences of being overweight or obese
Physical risks: hypertension, heart disease, stroke, diabetes, cancer, sleep
apnea, osteoarthritis, gout and gallbladder disease.
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Psychosocial risks:Depression about weight and eating, susceptibility to
hunger, disinhibition toward eating when stressed, target of prejudice,
viewed as less attractive, industrious, intelligent.
12.6 Biological influences
Genes do not cause obesity, although they may influence certain processes
that may help lead to it. Indirect evidence has stated heredity plays a part in
excess weight gain. If both parents are obese, for example, it is estimated
that the probability that their children will be obese is 80%, whereas if
neither parent is obese the chances of an obese child are less than 10%.
Research suggests that a large number of genes may play a role in the
development of obesity. Obese humans generally have high leptin levels, and
leptin concentrations usually increase with weight gain. It is therefore
speculated that leptin rises with weight gain in order to suppress appetite,
but that the obese are resistant to its action in the way that individuals with
Type 2 diabetes have high levels of insulin but are resistant to its action.
Leptin may promote a negative energy balance by not only suppressing
appetite but also by increasing energy expenditure.
Energy expenditure in this case is primarily affected by changes in basal
metabolism, which is responsible for up to two-thirds of the energy that the
body uses each day in support of metabolic activities such as respiration,
circulation, thermoregulation and so forth. The basal metabolic rate (BMR),
a clinical measure of resting energy expenditure, varies from person to
person and is tied to lean body mass. Therefore, conditions which alter lean
body mass such as age, weight and physical condition will affect energy
requirements and BMR.
Genes that code for uncoupling proteins may also prove to be important in
understanding the development of obesity. The human body has two types
of adipose tissue – the mostly white adipose tissue that stores fat for other
cells to use as energy, and brown adipose tissue that releases stored energy
as heat. When white adipose tissue is oxidized, the majority of the energy is
captured in adenosine triphosphate (ATP) and the remainder is released as
heat. In brown adipose tissue, oxidation may be uncoupled from ATP
formation producing only heat. This results in the body spending energy
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instead of storing it. The gene that codes for uncoupling protein-2 is active
in brown and white fat, and also influences BMR. Animals with high
amounts of this protein appear to resist weight gain, while those with
minimal amounts gain weight rapidly.
The development and metabolism of fat cells themselves may also contribute
to overweight and obesity. The amount of fat in a person’s body reflects both
the number and size of the fat cells that he or she possesses. The number of
fat cells increases most rapidly during late childhood and early adolescence
and more rapidly in obese children than in lean children. As fat cells fill with
fat droplets they increase in size, and may also divide if they reach their
maximum. Obesity can develop when a person’s fat cells increase in
number, size or both. With weight loss, the size of fat cells will reduce, but
not their number, and with subsequent weight gain they will readily be
refilled. The enzyme lipoprotein lipase (LPL) serves to promote fat storage in
fat cells. Obese individuals with high LPL activity store fat especially
efficiently, so that even a modest excess in their energy intake has a greater
impact than it would on lean people. After weight loss, LPL activity
increases, and will increase most in those individuals who were fattest prior
to their weight loss. In addition, LPL activity is partially regulated by
sexspecific hormones. The android and gynoid fat patterns that tend to
characterize men and women, respectively, are likely due to abundant LPL
activity in the fat cells of the male abdomen, and in the breasts, hips and
thighs of the female. The lower body is also less active than the upper body
in releasing fat from storage, which explains the greater difficulty in losing
weight from the hips and thighs than from around the stomach.
Researchers have determined that after weight loss, or weight gain for that
matter, the body adjusts its BMR so as to restore its original weight. Part of
this is due to the gene that produces the LPL enzyme appearing to signal the
storage of fat in the case where weight is lost, for example.
12.7 Behavioural influences
12.7.1 Energy expenditure
Lack of physical activity due to advances in technology and labor saving
devices
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Television watching increases the likelihood of obesity because it is a
sedentary activity, replaces time for activities requiring movement, minimal
attention is given to food ingested, food advertised may motivate purchase or
fast food consumption
12.7.2 Energy intake
Energy intake refers to the food we eat, or caloric intake; energy expenditure
is comprised of BMR, diet-induced thermogenesis (the body’s generation of
heat), and physical activity. Energy intake does not entirely explain why
some people become fat while others seem resistant to weight gain as other
factors such as genetics may play a role.
The dietary component of what is eaten matters:
 Fat - too much fat promotes obesity. Dietary fat provides more
kilocalories per gram and requires less energy to be metabolized, relative
to protein and carbohydrate.
 Total calories consumed e.g. larger portions at restaurants, fast food
joints.
 The price of food, greater variety at a low price.
 Where the food is consumed also matters, people tend to overeat at
restaurants.
 Stress may lead to overeating or binge eating.
 Overeating in children may be due to parents who attempt to control
their children’s eating by rewards or threats to coerce children to finish
their meals may lead to the unintended effect of increasing the child’s
tendency to be overweight. This is because such actions inadvertently
interfere with their child’s ability to self-regulate energy intake, by forcing
them to ignore internal feelings of satiety
12.8 Restrictive feeding practices
12.8.1 Very low calorie diets
Very-low-calorie diets (VLCDs), an approach deemed suitable for individuals
who are moderately obese, that is, from 41% to 100% over their ideal weight.
The typical VLCD plan provides no more than 800 kcal, at least 1 g of high-
quality protein per kg of body weight, and at least 50 g of carbohydrate,
which may not be enough to spare protein. Meals consist of a limited
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number of foods each day, primarily lean meats, fish and poultry, and often
a supplemental powdered formula available by prescription. Clients also
receive an assortment of vitamin and mineral supplements. When carefully
administered under medical supervision, VLCD diets appear to be relatively
safe, although side effects on blood pressure, heart muscle and hormones,
as well as headache, cold intolerance and fatigue, have been reported.
While designed to be nutritionally adequate, the body responds to this
severe energy restriction as if the person were starving, conserving energy by
reducing BMR and slowing fat oxidation. For this reason, a VCLD is only
appropriate for short-term use (i.e. 3–4 months), but may help the individual
lose some 20 kg (44 lb) over that time interval. Unfortunately, the near
starvation it creates primes the body to regain weight at the first
opportunity, with two-thirds of the weight loss being regained within a year.
Such a rapid loss of weight followed by a steady gain is likely to be
detrimental to both physical and psychological health.
12.8.2 Yo-yo dieting
Many individuals who diet will successfully lose weight, but very few are
able to maintain their loss for an extended period of time. Nevertheless, they
are likely to repeat the strategy of dieting to lose weight, regaining the weight
and dieting again, a behavioural pattern known as weight cycling or ‘yo-yo
dieting’
12.9 Preventive approaches
Preventing excessive weight gain in the first place is a sensible approach to
lifelong health and well-being. At an individual level the following strategies
are recommended:
 Eat regular meals and limit snacking
 Drink water instead of high kilocalorie beverages
 Regularly select low-fat foods
 Limit dietary fat to 30% of daily kilocalorie intake
 Become physically active
 Limit television-viewing time
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12.9.1 Weight management
This refers to striving for a healthy weight. Modest weight loss, even if a
person remains overweight, can reduce the risk of heart disease and
improve control of diabetes. A loss of just 10 to 15 lb (4.5–6.8 kg), for
example, can lower an individual’s BMI by two units, which will significantly
improve his or her health. However, experts recommend a loss of no more
than 5% to 10% per year.
Reducing blood pressure or cholesterol through diet and exercise is
therefore a more useful goal than is a mere focus on weight, although the
strategies used to do so will result likely in a healthier body weight and
composition as well. Unrealistic expectations for weight loss that many
people possess may prevent them from appreciating their actual
success.This underscores the role of psychology in weight loss, a factor that
along with eating and physical activity must be considered in managing
weight or treating obesity.
Diet composition
A small change in energy intake, such as a reduction of 200–300 kcal/day,
is more successful in long-term weight control than is trying to subsist on a
daily regimen of 1000–1200 kcal. A realistic energy intake should provide
less energy than the person needs to maintain their present body weight,
but a daily intake less than 1200 kcal/day could make it difficult to achieve
nutritional adequacy. Adequate intake will ensure more successful weight
loss than a severely restrictive plan that induces starvation and deprivation,
which can lead to bingeing.
A low-fat diet will more readily satisfy their hunger and eat less food but it
must be high in carbohydrate and adequate in protein. Even low-fat foods
provide excessive calories if eaten in mass quantities.
Complex carbohydrate foods such as fresh fruits, vegetables, legumes and
whole grains are low in fat but also rich in vitamins, minerals and fiber.
Highfiber foods are also beneficial because they require more effort to chew,
in effect slowing down intake while having a strong satiety effect. Water,
which assists the gastrointestinal tract in adapting to a high-fiber diet, will
also help to fill the stomach between meals and dilute the metabolic wastes
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that the breakdown of fat generates. Drinking water frequently is therefore a
useful strategy in maintaining weight. Drinking just any liquid, however, is
not as beneficial as plain water. Alcoholic beverages are high in calories but
low in major nutrients, as are regular soft drinks with their high-sugar
content.
Physical activity
Regular physical activity is an essential component of weight management.
Aerobic activities such as walking or jogging burn calories directly, while
anaerobic activities such as sit ups or lifting weights serve to build muscle
mass. In addition, regular exercise can discourage overeating by reducing
stress, can produce positive feelings that reinforce a sense of well-being, and
will often promote positive social interactions. Overweight individuals who
combine diet and exercise may be more likely to lose fat, retain more muscle
and regain less weight than those who only diet.
Physical activity has a direct effect on energy expenditure. While regular
exercise of moderate intensity will improve health, in order to lose fat,
exercise should be as vigorous as physical shape and time will permit, with
intensity offset by the amount of time that is available
Activity also contributes to energy expenditure indirectly by speeding up
basal metabolism. Basal metabolism immediately rises after intense and
prolonged exercise and will remain elevated for several hours. Over many
weeks, however, daily vigorous exercise will build more lean tissue, changing
overall body composition. Since lean tissue is more metabolically active,
there will be a corresponding rise in BMR, resulting in better weight
maintenance. Physically active individuals are likely to possess good
appetites, but exercise itself and eating are incompatible. To support
exercise the body must release glucose and fatty acids into the blood as
fuels, and simultaneously suppresses its digestive functions. Moreover, by
displacing the act of eating, exercise may actually help to curb appetite,
especially if anxiety, boredom or depression are typical triggers of overeating
for the individual.
Behaviour change
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Behavioural programs designed to facilitate weight management typically
include a number of strategies that rely on cognitive-behavioural change.
These include self-monitoring, goal setting, stimulus control, problem
solving, cognitive restructuring and relapse prevention.
For example, in self-monitoring the individuals are taught to write down
everything they eat, the caloric content of the foods eaten, as well as the
grams of fat. After a few weeks in the weight-loss program, the self-
monitoring of physical activity is added. During the initial weeks of a
program daily self-monitoring is prescribed, but it may be reduced to
periodic self-monitoring when sufficient weight is lost and weight
maintenance is desired.
Stimulus control involves managing the near environment so as to avoid
cues that encourage inappropriate eating, or to institute new cues that elicit
desirable behaviors. This may include the individual being instructed to
place energy-dense foods out of sight and to set up visible reminders to
exercise.
Cognitive restructuring refers to eliminating rationalizations for
inappropriate eating, as well as countering negative thoughts with positive
statements that build self-acceptance.
Stress management involves identifying cues that trigger overeating is a
useful way to avoid temptation. Among binge eaters, in particular, chocolate
is often eaten under the mistaken belief that it will help to alleviate stress.
12.10Treatment and preventive approaches
12.10.1 Surgery
The use of surgery as a treatment for weight loss is clearly the most radical
form of therapy for the obese. For individuals who are morbidly obese (i.e.
100% or more overweight), this approach has been shown to help those with
a severe weight problem to maintain large weight losses for an extended
period.
Types of surgery
1. Jejunoileal bypass
It was the first extensively used surgical procedure for the treatment of
obesity. The absorptive surface of the small intestine is reduced in length.
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Patients reported reduced food intake, including less bingeing, snacking and
emotional eating, fewer meals and cravings, and smaller portions, along with
positive changes in mood, activity level, self-esteem and assertiveness.
Weight loss in excess of 100 lb was typical, but the mortality rate from the
procedure ranged from 3–4% and other complications were quite significant.
2. Vertical banded gastroplasty surgery that reduces the stomach’s capacity
by creating a small pouch.
3. Gastric bypass surgery routes food almost directly to the jejunum,
bypassing the duodenum and most of the stomach. Complications can
still arise, but the mortality rate is a less dangerous 1%.
4. Intragastric balloon approach involves a balloon being inserted into the
stomach to reduce gastric capacity. Besides complications such as
vomiting, ulcers and intestinal obstructions, weight gain typically returns
when the balloon is deflated.
5. Jaw wiring, the patient can be expected to lose 4–5 lb (2 kg) per month
because of the inability to ingest solid foods and masticate. However,
once the wires are removed, patients commonly regain their lost weight.
6. Liposuction, which consists of suctioning off subcutaneous fat, has been
employed by many to remove targeted fat deposits. This procedure can
alter body shape slightly, but has little effect on weight as the body still
has billions of fat cells that can store extra fat. Popular basically for
cosmetic reasons, any improvement in appearance is more than offset by
the health risks that include blood clots and nerve damage.
12.10.2 Drugs
Early drugs acted to reduce hunger, trigger satiety or stimulate energy
expenditure, the newer drugs serve to block the absorption of calories from
fat. The current focus is on drugs with distinct mechanisms of action that
can be used in conjunction with proper diet and exercise. Anti-obesity drugs
may inhibit energy intake, inhibit fat absorption, enhance energy
expenditure or stimulate fat mobilization.
An ideal anti-obesity drug should meet the following criteria:
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o A sustained loss of weight though a reduction in body fat with a sparing
of body protein
o Maintenance of the weight loss once a desirable body weight has been
achieved
o Absence of side effects or abuse liability when the drug is chronically
administered
o Improved compliance with a weight reduction program of diet and
exercise
Examples of drugs used in obesity
Phentermine (Fastin™ or Phentrol™) - Suppresses appetite
Mazindol (Sanorex™) - Suppresses appetite
Diethylproprion (Tenuate™) - Suppresses appetite
Clortermine (Voranil™) - Suppresses appetite
TM – Stands for Trade Name

Discuss weight management in obesity
Research onemerging issues and trends in nutrition and behaviour
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Dip - Principles of Nutrition and Behaviour - Draft

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Dip - Principles of Nutrition and Behaviour - Draft

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LIST OF ABBREVIATIONS

USA United States of America

By the end of this unit the learner should be able to;

1. Define terms used in nutrition and behaviour

1.2Introduction to nutrition and behaviour

In the same manner, a nutrition credential exists in the form of the

Certain populations are particularly target for quackery e.g.

3.2 Experimental approaches

3.2.3 Independent and Dependent Variables

3.3 Co-relational approaches

4.3The role of nutrients in brain development

4.3.1 Lipids and fatty acids

4.5Cholesterol and adult behaviour

4.6Cholesterol and antisocial behaviour

4.7Cholesterol and cognitive function

5.2 To explain the role of macro and micronutrients on behaviour

5.3 B Vitamins, central nervous system and behaviour

Pyridoxine (vitamin B6)

Cobalamin (vitamin B12)

Folate (vitamin B9)

In conclusion, intake of essential minerals is important for normal brain

PEM, Brain Development and Behavior

Severe protein malnutrition in early development results in failure to

continued development of the fetus but will lead to changes in growth of

marasmus develops at young ages compared to kwashiorkor, a marasmic

6.5 Check your understanding

Vitamins B6, B9 and B12

Therefore, bio-behavioural and psychological influence on nutrition explores

Neophobia and familial interactions

Genetic variation in Taste and Food Selection

Food plays an important role in life, as a source of pleasure, health and

Food Avoidance and Rejection

Cost/ Convenience/ Availability of Food

Dietary Restraint and Disinhibition

Individuals who are deemed to be psychosocially healthy aren't completely

The thinking portion of psychosocial health is known as mental health.

The feeling part of psychosocial health is called emotional health. This

Emotional intelligence is also an important aspect of psychosocial health.

The final aspect of psychosocial health is spiritual health, a belief in a force

Psychological Determinants of Nutrition

Psychological stress is a common feature of modern life and can modify

8.5 Check your understanding

The past few decades have seen an explosion of sugar-containing foods

9.2.1 Metabolism of sugar

Caffeine and sleep

Caffeine and cognitive behavior

Food additives and the impact on mood and behavior

Examples of food additives

Nutritional value of alcoholic beverages

Nutritional status of alcoholics

Effects of Alcohol on Blood sugar

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Clinical features of anorexia nervosa

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Psychological characteristics of anorexia nervosa

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